Adapting Peer Researcher Facilitated Strategies to Recruit People Receiving Mental Health Services to a Tobacco Treatment Trial

Abstract

IntroductionOne of the most challenging aspects of conducting intervention trials among people who experience severe mental illness (SMI) and who smoke tobacco, is recruitment. In our parent “QuitLink” randomized controlled trial (RCT), slower than expected peer researcher facilitated recruitment, along with the impact of COVID-19 pandemic restrictions, necessitated an adaptive recruitment response. The objectives of the present study were to: (i) describe adaptive peer researcher facilitated recruitment strategies; (ii) explore the effectiveness of these strategies; (iii) investigate whether recruitment strategies reached different subgroups of participants; and (iv) examine the costs and resources required for implementing these strategies. Finally, we offer experience-based lessons in a Peer Researcher Commentary.MethodsPeople were included in the RCT if they smoked at least 10 cigarettes a day and were accessing mental health support from the project's two partnering mental health organizations in Victoria, Australia. The majority of people accessing these services will have been diagnosed with SMI. Recruitment occurred over 2 years. We began with peer facilitated recruitment strategies delivered face-to-face, then replaced this with direct mail postcards followed by telephone contact. In the final 4 months of the study, we began online recruitment, broadening it to people who smoked and were accessing support or treatment (including from general practitioners) for mental health and/or alcohol or other drug problems, anywhere in the state of Victoria. Differences between recruitment strategies on key participant variables were assessed. We calculated the average cost per enrolee of the different recruitment approaches.ResultsOnly 109 people were recruited from a target of 382: 29 via face-to-face (March 2019 to April 2020), 66 from postcards (May 2020 to November 2020), and 14 from online (November to December 2020 and January to March 2021) strategies. Reflecting our initial focus on recruiting from supported independent living accommodation facilities, participants recruited face-to-face were significantly more likely to be living in partially or fully supported independent living (n = 29, <0.001), but the samples were otherwise similar. After the initial investment in training and equipping peer researchers, the average cost of recruitment was AU$1,182 per participant—~US$850. Face-to-face recruitment was the most expensive approach and postcard recruitment the least (AU$1,648 and AU$928 per participant).DiscussionPeer researcher facilitated recruitment into a tobacco treatment trial was difficult and expensive. Widely dispersed services and COVID-19 restrictions necessitated non-face-to-face recruitment strategies, such as direct mail postcards, which improved recruitment and may be worthy of further research.Clinical Trial Registration:The trial is registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines. The trial sponsor was the University of Newcastle, NSW, Australia.

‘Quitlink’: Outcomes of a randomised controlled trial of peer researcher facilitated referral to a tailored quitline tobacco treatment for people receiving mental health services

“… AUDIT-C: Alcohol Use Disorders Identification Test – Brief; AQoL-8D: Assessment of Quality of Life-8D; CUDIT-R: Cannabis Use Disorders Identification Test – Revised; CO: carbon monoxide; EQ-5D: EuroQoL 5-deimension; HRQL: Health-related quality of life; Kessler-10: Kessler Psychological Distress Scale; MINI: Mini International Neuropsychiatric Interview; NRT: nicotine replacement therapy; GP – general practitioner; WAIT-3: Working Alliance Inventory for Tobacco-3; MBS: Medicare Benefits Scheme; PBS: Pharmaceutical Benefits Scheme. Key * – If not captured at previous assessment. E – Extracted data. S – Current smokers. # – For those who used Quitline. T – Via telephone if a participant recruited online. ^ – To minimise participant survey burden as we moved away from face-to-face recruitment, we transitioned from capturing HRQL using the AQoL-8D instrument, which has strong psychosocial dimension properties, to the EQ-5D-5L plus four AQol-8D bolt-on questions (Baker et al, 2022). These can be used in combination to calculate HRQL utilities and has been shown to be comparable to the AQOL-8D (Chen and Olsen, 2020) …”

“…Study recruitment occurred between March 2019 and April 2021, with the 8-month post-baseline follow-up finalised in December 2021. As described in detail elsewhere ( Baker et al, 2019 ; Sweeney et al, 2019 ), peer-facilitated recruitment strategies were adapted from face-to-face to direct mail (postcard) and online due to lower than expected recruitment, in part due to the impact of COVID-19 pandemic restrictions ( Baker et al, 2022 ). Following provision of informed consent, baseline data were collected at enrolment within Research Electronic Data Capture (REDCap; Harris et al, 2009 , 2019 ) via an iPad.…”

“… T – Via telephone if a participant recruited online. ^ – To minimise participant survey burden as we moved away from face-to-face recruitment, we transitioned from capturing HRQL using the AQoL-8D instrument, which has strong psychosocial dimension properties, to the EQ-5D-5L plus four AQol-8D bolt-on questions ( Baker et al, 2022 ). These can be used in combination to calculate HRQL utilities and has been shown to be comparable to the AQOL-8D ( Chen and Olsen, 2020 ) …”

“…Costs associated with control and Quitlink were determined for each person using Quitline (staff time and call costs) and cNRT costs. We also included postcard mail outs as costs, as this is a likely strategy for reaching potential clients beyond the trial (see Baker et al, 2022 ). Costs were calculated in AUD 2021.…”

“…Primary outcome. Due to COVID-19 restrictions on inperson contact, the primary outcome was modified from biochemically (carbon monoxide, CO) verified to self-reported prolonged abstinence from tobacco smoking since the end of Current smoking and quit attempts X X X X 7-day point prevalence abstinence X X X 6-month prolonged abstinence (primary outcome) X Heaviness of smoking index (Heatherton et al, 1989;Kozlowski et al, 1994 ^-To minimise participant survey burden as we moved away from face-to-face recruitment, we transitioned from capturing HRQL using the AQoL-8D instrument, which has strong psychosocial dimension properties, to the EQ-5D-5L plus four AQol-8D bolt-on questions (Baker et al, 2022). These can be used in combination to calculate HRQL utilities and has been shown to be comparable to the AQOL-8D (Chen and Olsen, 2020) the treatment period (i.e.…”