scholarly journals Recruiting people facing social disadvantage: the experience of the Free Meds study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Pauline Norris ◽  
Kimberly Cousins ◽  
Marianna Churchward ◽  
Shirley Keown ◽  
Mariana Hudson ◽  
...  
Keyword(s):  
Social Deprivation ◽  
Controlled Trial ◽  
Social Disadvantage ◽  
Health Providers ◽  
Access To Health Services ◽  
Team Members ◽  
Recruitment Methods ◽  
Advantages And Disadvantages ◽  
Randomised Controlled ◽  
Maori Health

Abstract Background Researching access to health services, and ways to improve equity, frequently requires researchers to recruit people facing social disadvantage. Recruitment can be challenging, and there is limited high quality evidence to guide researchers. This paper describes experiences of recruiting 1068 participants facing social disadvantage for a randomised controlled trial of prescription charges, and provides evidence on the advantages and disadvantages of recruitment methods. Methods Those living in areas of higher social deprivation, taking medicines for diabetes, taking anti-psychotic medicines, or with COPD were eligible to participate in the study. Several strategies were trialled to meet recruitment targets. We initially attempted to recruit participants in person, and then switched to a phone-based system, eventually utilising a market research company to deal with incoming calls. We used a range of strategies to publicise the study, including pamphlets in pharmacies and medical centres, media (especially local newspapers) and social media. Results Enrolling people on the phone was cheaper on average than recruiting in person, but as we refined our approach over time, the cost of the latter dropped significantly. In person recruitment had many advantages, such as enhancing our understanding of potential participants’ concerns. Forty-nine percent of our participants are Māori, which we attribute to having Māori researchers on the team, recruiting in areas of high Māori population, team members’ existing links with Māori health providers, and engaging and working with Māori providers. Conclusions Recruiting people facing social disadvantage requires careful planning and flexible recruitment strategies. Support from organisations trusted by potential participants is essential. Registration The Free Meds study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001486213).

scholarly journals Recruiting people facing social disadvantage: the experience of the Free Meds study

2021 ◽  
Author(s):  
Pauline Norris ◽  
Kimberly Cousins ◽  
Kimberly Cousins ◽  
Marianna Churchward ◽  
Marianna Churchward ◽  
...  
Keyword(s):  
Social Deprivation ◽  
Controlled Trial ◽  
Social Disadvantage ◽  
Health Providers ◽  
Access To Health Services ◽  
Team Members ◽  
Recruitment Methods ◽  
Advantages And Disadvantages ◽  
Randomised Controlled ◽  
Maori Health

Abstract Background Researching access to health services, and ways to improve equity, frequently requires researchers to recruit people facing social disadvantage. Recruitment can be challenging, and there is limited high quality evidence to guide researchers. This paper describes experiences of recruiting 1068 participants facing social disadvantage for a randomised controlled trial of prescription charges, and provides evidence on the advantages and disadvantages of recruitment methods. Methods Those living in areas of higher social deprivation, taking medicines for diabetes, taking anti-psychotic medicines, or with COPD were eligible to participate in the study. Several strategies were trialled to meet recruitment targets. We initially attempted to recruit participants in person, and then switched to a phone-based system, eventually utilising a market research company to deal with incoming calls. We used a range of strategies to publicise the study, including pamphlets in pharmacies and medical centres, media (especially local newspapers) and social media. Results Enrolling people on the phone was cheaper on average than recruiting in person, but as we refined our approach over time, the cost of the latter dropped significantly. In person recruitment had many advantages, such as enhancing our understanding of potential participants’ concerns. Forty-nine percent of our participants are Māori, which we attribute to having Māori researchers on the team, recruiting in areas of high Māori population, team members’ existing links with Māori health providers, and engaging and working with Māori providers. Conclusions Recruiting people facing social disadvantage requires careful planning and flexible recruitment strategies. Support from organisations trusted by potential participants is essential. Registration: The Free Meds study is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618001486213).

scholarly journals Recruiting and retaining general practitioners to a primary care asthma-intervention study in Australia

2014 ◽  
Vol 20 (1) ◽  
pp. 98 ◽  
Author(s):  
Smita Shah ◽  
Jessica K. Roydhouse ◽  
Brett G. Toelle ◽  
Craig M. Mellis ◽  
Christine R. Jenkins ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Retention Rate ◽  
Controlled Trial ◽  
Independent Research ◽  
Project Staff ◽  
Recruitment Methods ◽  
General Practices ◽  
Randomised Controlled ◽  
First Contact

The need for more evidence-based interventions in primary care is clear. However, it is challenging to recruit general practitioners (GPs) for interventional research. This paper reports on the evaluation of three methods of recruitment that were sequentially used to recruit GPs for a randomised controlled trial of an asthma communication and education intervention in Australia. The recruitment methods (RMs) were: general practices were contacted by project staff from a Department of General Practice, University of Sydney (RM1); general practices were contacted by staff from an independent research organisation (RM2); and general practices were contacted by a medical peer (chief investigator) (RM3). A GP was defined as ‘recruited’ once they consented and were randomised to a group, and ‘retained’ if they provided baseline data and did not notify staff of their intention to withdraw at any time during the 12-month study. RM1 was used for the first 6 months, during which 34 (4%) GPs were recruited and 21 (62%) retained from a total of 953 invitations. RM2 was then used for the next 5 months, during which 32 (6%) GPs were recruited and 26 (81%) were retained. Finally over the next 7 months, RM3 recruited 84 (12%) GPs and retained 75 (89%) GPs. In conclusion, use of a medical peer as the first contact was associated with the highest recruitment and retention rate.

scholarly journals When is a randomised controlled trial health equity relevant? Development and validation of a conceptual framework

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e015815 ◽  
Author(s):  
J Jull ◽  
M Whitehead ◽  
M Petticrew ◽  
E Kristjansson ◽  
D Gough ◽  
...  
Keyword(s):  
Conceptual Framework ◽  
Health Equity ◽  
Controlled Trial ◽  
Randomised Trial ◽  
Evidence Base ◽  
Social Disadvantage ◽  
Randomised Trials ◽  
Individual Level ◽  
International Research Team ◽  
Randomised Controlled

BackgroundRandomised controlled trials can provide evidence relevant to assessing the equity impact of an intervention, but such information is often poorly reported. We describe a conceptual framework to identify health equity-relevant randomised trials with the aim of improving the design and reporting of such trials.MethodsAn interdisciplinary and international research team engaged in an iterative consensus building process to develop and refine the conceptual framework via face-to-face meetings, teleconferences and email correspondence, including findings from a validation exercise whereby two independent reviewers used the emerging framework to classify a sample of randomised trials.ResultsA randomised trial can usefully be classified as ‘health equity relevant’ if it assesses the effects of an intervention on the health or its determinants of either individuals or a population who experience ill health due to disadvantage defined across one or more social determinants of health. Health equity-relevant randomised trials can either exclusively focus on a single population or collect data potentially useful for assessing differential effects of the intervention across multiple populations experiencing different levels or types of social disadvantage. Trials that are not classified as ‘health equity relevant’ may nevertheless provide information that is indirectly relevant to assessing equity impact, including information about individual level variation unrelated to social disadvantage and potentially useful in secondary modelling studies.ConclusionThe conceptual framework may be used to design and report randomised trials. The framework could also be used for other study designs to contribute to the evidence base for improved health equity.

scholarly journals Commentary: Pivoting during a pandemic: developing a new recruitment model for a randomised controlled trial in response to COVID-19

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shakira Milton ◽  
Jennifer McIntosh ◽  
Lucy Boyd ◽  
Napin Karnchanachari ◽  
Finlay Macrae ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
High Rate ◽  
Main Body ◽  
Waiting Room ◽  
Recruitment Methods ◽  
Face To Face ◽  
Recruitment Bias ◽  
Australian State ◽  
Randomised Controlled

Abstract Background Many non-COVID-19 trials were disrupted in 2020 and either struggled to recruit participants or stopped recruiting altogether. In December 2019, just before the pandemic, we were awarded a grant to conduct a randomised controlled trial, the Should I Take Aspirin? (SITA) trial, in Victoria, the Australian state most heavily affected by COVID-19 during 2020. Main body We originally modelled the SITA trial recruitment method on previous trials where participants were approached and recruited in general practice waiting rooms. COVID-19 changed the way general practices worked, with a significant increase in telehealth consultations and restrictions on in person waiting room attendance. This prompted us to adapt our recruitment methods to this new environment to reduce potential risk to participants and staff, whilst minimising any recruitment bias. We designed a novel teletrial model, which involved calling participants prior to their general practitioner appointments to check their eligibility. We delivered the trial both virtually and face-to-face with similar overall recruitment rates to our previous studies. Conclusion We developed an effective teletrial model which allowed us to complete recruitment at a high rate. The teletrial model is now being used in our other primary care trials as we continue to face the impacts of the COVID-19 pandemic.

Medical crisis checklists in the emergency department: a simulation-based multi-institutional randomised controlled trial

2021 ◽  
pp. bmjqs-2020-012740
Author(s):  
Eric Dryver ◽  
Jakob Lundager Forberg ◽  
Caroline Hård af Segerstad ◽  
William D Dupont ◽  
Anders Bergenfelz ◽  
...  
Keyword(s):  
Similar Case ◽  
Controlled Trial ◽  
Haemorrhagic Shock ◽  
Primary Outcome Measure ◽  
Tricyclic Antidepressant ◽  
Median Percentage ◽  
Team Members ◽  
Senior Nurse ◽  
Emergency Interventions ◽  
Randomised Controlled

BackgroundStudies carried out in simulated environments suggest that checklists improve the management of surgical and intensive care crises. Whether checklists improve the management of medical crises simulated in actual emergency departments (EDs) is unknown.MethodsEight crises (anaphylactic shock, life-threatening asthma exacerbation, haemorrhagic shock from upper gastrointestinal bleeding, septic shock, calcium channel blocker poisoning, tricyclic antidepressant poisoning, status epilepticus, increased intracranial pressure) were simulated twice (once with and once without checklist access) in each of four EDs—of which two belong to an academic centre—and managed by resuscitation teams during their clinical shifts. A checklist for each crisis listing emergency interventions was derived from current authoritative sources. Checklists were displayed on a screen visible to all team members. Crisis and checklist access were allocated according to permuted block randomisation. No team member managed the same crisis more than once. The primary outcome measure was the percentage of indicated emergency interventions performed.ResultsA total of 138 participants composing 41 resuscitation teams performed 76 simulations (38 with and 38 without checklist access) including 631 interventions. Median percentage of interventions performed was 38.8% (95% CI 35% to 46%) without checklist access and 85.7% (95% CI 80% to 88%) with checklist access (p=7.5×10−8). The benefit of checklist access was similar in the four EDs and independent of senior physician and senior nurse experience, type of crisis and use of usual cognitive aids. On a Likert scale of 1–6, most participants agreed (gave a score of 5 or 6) with the statement ‘I would use the checklist if I got a similar case in reality’.ConclusionIn this multi-institution study, checklists markedly improved local resuscitation teams’ management of medical crises simulated in situ, and most personnel reported that they would use the checklists if they had a similar case in reality.

scholarly journals An Application of PRECIS-2 to Evaluate Trial Design in a Pilot Cluster Randomised Controlled Trial of a Community-based Smoking Cessation Intervention for Women Living in Disadvantaged Areas of Ireland

2021 ◽  
Author(s):  
Catherine Darker ◽  
Kirsty Loudon ◽  
Nicola O'Connell ◽  
Stefania Castello ◽  
Emma Burke ◽  
...  
Keyword(s):  
Trial Design ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Cluster Randomised Controlled Trial ◽  
Community Based ◽  
Team Members ◽  
Disadvantaged Communities ◽  
Cluster Randomised ◽  
Randomised Controlled

Abstract Background “We Can Quit2” (WCQ2) was a pilot cluster randomised controlled trial with an embedded process evaluation assessing the feasibility and acceptability of ‘We Can Quit’ (WCQ), a peer-delivered community-based stop-smoking programme for women in disadvantaged communities. The control group comprised ‘enhanced usual care’ offered by the Irish Health Service Executive (HSE). The PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) is a tool to assess whether a trial design is more explanatory (working under ideal conditions) or pragmatic (working under ‘real world’ conditions). The aim of this paper was to retrospectively evaluate the WCQ2 pilot trial using PRECIS-2 to inform the decision-making process on progression to a future definitive trial (DT).Methods The WCQ2 trial protocol and HSE standard stop-smoking service were described across the nine PRECIS-2 domains: Eligibility, Recruitment, Setting, Organisation, Flexibility-Delivery, Flexibility-Adherence, Follow-up, Primary Outcome. Team members scored the domains as pragmatic or explanatory for each arm in a half-day workshop. Results Seven team members (practitioners and researchers) assessed the overall trial design as more explanatory than pragmatic. Important differences emerged between the two arms. WCQ targeted adult women from disadvantaged communities whereas HSE run a limited enhanced service for all quitters. Recruitment to trial was challenging, intense efforts were needed as the trial proceeded. WCQ was delivered in a non-clinical community setting, HSE services in a clinical setting. WCQ organisation was co-designed with community partners and comprises peer-to-peer group support delivered by trained lay community facilitators, whereas HSE one-to-one support is delivered by Smoking Cessation Officers with a clinical background. Only WCQ allowed flexibility in delivery and adherence. Follow-up was more intensive in WCQ. Greater efforts to improve participant retention will be required in a future DT. Conclusions PRECIS-2 allowed the reflection of practitioners and researchers on similarities and differences between intervention and control arms. Results will inform the decision on progression to an effectiveness DT, which will require more a pragmatic and less explanatory design. This novel use of PRECIS-2 to retrospectively evaluate a complex community-based pilot trial in advance of a full DT will also support learning for those undertaking hybrid trials of implementation and effectiveness. Trial registration: This trial is registered with the ISRCTN registry (No. 74721694), available at https://doi.org/10.1186/ISRCTN74721694

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