Use of strategies to improve retention in primary care randomised trials: a qualitative study with in-depth interviews

Abstract

ObjectiveTo explore the strategies used to improve retention in primary care randomised trials.DesignQualitative in-depth interviews and thematic analysis.Participants29 UK primary care chief and principal investigators, trial managers and research nurses.MethodsIn-depth face-to-face interviews.ResultsPrimary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers.ConclusionsThe findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.

Interventions to improve retention in a surgical, clinical trial: A pragmatic, stakeholder‐driven approach

“…Previous research has been inconclusive about how best to respond to difficulties in trial retention; multiple strategies have been offered but few are supported by a strong evidence base . The stakeholder‐driven approach that we employed is informed by this uncertainty and by a body of literature which points to the value of trial‐specific insight and strategies . While the insights discussed here were in the context of a surgical trial with a predominantly male and younger population, they could be potentially considered for trials in general.…”

“…More general assessment suggests that trial context, research population, and specific trial procedures significantly impact upon attrition and that qualitative investigation is important in the production of trial‐specific retention strategies . Elsewhere, others have pointed to the value of integrating qualitative research within clinical trials to further inform the research process and bodies such as INVOLVE and the James‐Lind Alliance (http://www.lindalliance.org) point to the importance of engaging stakeholders in the generation, operation, and management of clinical studies …”

“…A growing body of work demonstrates the value of engaging stakeholders in this way and highlights how qualitative investigation might: expose specific misunderstandings about trial processes; illuminate local organizational cultures and norms; map distinctive characteristics; identify important environmental factors; and expose researcher attitudes which are impacting upon trial operation …”

“…stakeholders in the generation, operation, and management of clinical studies. [21][22][23][24][25] A growing body of work demonstrates the value of engaging stakeholders in this way [26][27][28][29][30] and highlights how qualitative investigation might: expose specific misunderstandings about trial processes; 31 illuminate local organizational cultures and norms; 11 map distinctive characteristics; 32,33 identify important environmental factors; 16 and expose researcher attitudes which are impacting upon trial operation. 34 Here, we consider a stakeholder-consultative process to inform retention strategies in the Scaphoid Waist internal Fracture Fixation Trial (SWIFFT) (http://www.nets.nihr.ac.uk/projects/hta/113637).…”

Use of a motivational interviewing-informed strategy in group orientations to improve retention and intervention attendance in a randomized controlled trial

“…Numerous strategies for improving participant retention and treatment adherence have been recommended in the literature [4][5][6][7]; however, the actual rates reported in systematic reviews of lifestyle intervention trials suggest challenges. The average retention rate across lifestyle intervention studies was $70% in various systematic reviews including intervention RCTs in primary care settings specifically [8][9][10][11].…”