Facilitators and challenges in recruiting pregnant women to an infant obesity prevention programme delivered via telephone calls or text messages

Abstract

BackgroundRecruitment of pregnant women into trials is a challenge exacerbated by a number of factors, including strict eligibility criteria. There has been little in-depth examination of the recruitment process to trials involving pregnant women. This paper presents the findings of a study conducted to identify facilitators and challenges in recruiting pregnant women to the Communicating Healthy Beginnings Advice by Telephone (CHAT) randomised controlled trial, which aims to reduce the prevalence of infant and childhood obesity.MethodsData were collected from (1) administration of a short questionnaire to women at the time of recruitment exploring women’s reasons for consent and non-consent; (2) interviews with recruiters to capture recruiters’ experiences of the recruitment process; and (3) analysis of field notes taken by recruiters on the number of women approached/recruited and reasons as to why they did not consent to participate. Data obtained were triangulated to gain insights into the process of recruiting pregnant women.ResultsA total of 1155 pregnant women (mean gestational age 31.5 weeks) were enrolled over 5 months. The main reasons for women consenting to participate in the study were convenience in programme delivery mode via telephone calls or text messages, altruism and because the programme was free of charge. The main reasons for women not consenting were lack of interest, language challenges/difficulty speaking English and some felt they did not need information and support due to prior experience as a mother. Facilitators included organisational support, rapport with recruiters and some women with no other children who needed advice. Despite the challenges, the mode of delivery of intervention via telephone calls or text messages, the minimal effort required of women to participate, organisational support from the lead site and recruiters’ knowledge of and commitment towards the trial contributed towards successful recruitment.ConclusionDespite some challenges in recruiting pregnant women to an infant obesity prevention programme, some of the facilitators in recruitment included mode of delivery of the intervention programme via telephone calls or text messages, the minimal effort required for women to participate, organisational support from the lead site, and recruiters’ knowledge of and commitment towards the trial.Trial registrationThe CHAT RCT is registered with the Australian Clinical Trial Registry (ACTRN12616001470482p); Ethics Review Committee of Sydney Local Health District (Protocol No. X16–0360 & LNR/16/RPAH/495).

Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review

“…We found no evidence of evaluation of perceptions of other key stakeholders including those who delivered the interventions or health managers or policymakers, and no evidence of other process evaluation measures such as reach or fidelity. Process evaluation findings highlight participants' appreciation of the convenience of receiving interventions via telephone or text messages [63,69], and the importance of delivering interventions from credible sources for participants' compliance with interventions and behaviour changes [63][64][65]67]. Level of engagement in a program was not dependent on the mode of delivery but was dictated by participants' needs and on their children's developmental stage [33,63,67].…”

“…All eight studies quantitatively measured participant satisfaction at the time interventions were delivered. Qualitative interviews with trial participants were conducted by three studies during the intervention phase [63][64][65] and by five studies post-intervention [32,33,[66][67][68], with only one study measuring perceptions of participants and recruiters during the recruitment phase [69]. Details of this analysis are shown in supplementary file 1.…”

“…Five studies evaluated participants' perceptions upon completion of the intervention or postintervention period through semi-structured interviews [68], semi-structured telephone interviews with purposive sampling [67], qualitative interviews [66], a questionnaire with open-ended process evaluation questions [32] and an in-person exit interview [33]. Additional process evaluation components included examination of researchers' diaries, field records, project meeting minutes [64], and interviews with participants and recruiters during the recruitment phase to assess facilitators and challenges in recruiting pregnant women to trials [69] (Table 6). Process evaluation of the recruitment phase of the studies indicated that participants consented to participate due to the convenience of the delivery mode via telephone or text messages [69].…”

“…Additional process evaluation components included examination of researchers' diaries, field records, project meeting minutes [64], and interviews with participants and recruiters during the recruitment phase to assess facilitators and challenges in recruiting pregnant women to trials [69] (Table 6). Process evaluation of the recruitment phase of the studies indicated that participants consented to participate due to the convenience of the delivery mode via telephone or text messages [69]. Evaluation of participants' experience indicated that participants were likely to modify behaviour if they received information from a credible source such as from health professionals [63][64][65]67].…”

Participant Experiences of an Infant Obesity Prevention Program Delivered via Telephone Calls or Text Messages

“…The CHAT RCT was conducted across four Local Health Districts (LHDs) within New South Wales (NSW) Australia, where pregnant women were recruited at eight hospital sites between February and July 2017. The study protocol, eligibility criteria, recruitment process and outcomes are reported in detail elsewhere [13,22,23]. In brief, CHAT is a three-arm RCT that compares: mailed HB booklets plus telephone support (telephone); to mailed HB booklets plus text messages or Short Message Service (SMS); to the control arm.…”