Perceived barriers and facilitators of staff recruiting participants to a randomised controlled trial of a community rehabilitation intervention following hip fracture.

Perceived barriers and facilitators of staff recruiting participants to a randomised controlled trial of a community rehabilitation intervention following hip fracture.

Publication date: Dec 18, 2024

Randomised controlled trials (RCTs) often struggle with recruitment and many need extensions which leads to delayed implementation of effective interventions. Recruitment to complex intervention trials have similar difficulties. Alongside this, the COVID-19 pandemic had a major impact upon trial recruitment. Research has shown that many other recruitment issues can be anticipated, for example overestimating target population prevalence; however, a range of factors may play a role. The aim of this study is to investigate facilitators and barriers to recruitment from the perspective of the recruiter. Fracture in the Elderly Multidisciplinary Rehabilitation – phase III (FEMuR III) was a RCT of a complex intervention post-surgery for hip fracture in patients over 60 years old. A process evaluation was undertaken, and semi-structured interviews were conducted with seven recruiters between November 2022 and March 2023 to identify barriers and facilitators to recruitment. A thematic analysis was undertaken in NVIVO (Version 12) using a critical realist perspective. The trial took place mostly during the COVID-19 pandemic, and the unique impact of this on reported barriers is considered. A key finding included recruiter reluctance to approach patients that they felt would not benefit from the trial due to other factors (e. g. comorbidities or complex living situations). A possible barrier to recruiting carers appeared to be that family members did not relate to the label of ‘carer’ and so did not take part. Facilitators included recruiters approaching patients with other clinical or research staff. This approach, which included tailored initial information on the trial, reduced participant stress by increasing patient familiarity with recruiting staff and allowing staff time to develop relationships with patients. This paper identifies barriers and facilitators of recruitment to FEMuR III with six broad themes for both barriers and facilitators identified in the qualitative data synthesis. The impact of the COVID-19 pandemic was the main, but not sole, barrier to recruitment. Key findings concern reluctance to approach some eligible patients, the label of ‘carer’, the involvement of clinical staff and patient preference for trial group. Strategies to identify and overcome recruitment problems are highlighted and should be implemented and evaluated in further RCTs of complex interventions. ISRCTN28376407. November 23, 2018.

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Concepts Keywords
Increasingpatient Aged
Isrctn28376407 COVID-19
Pandemic Elderly medicine
Recruiters Female
Surgery Hip Fractures
Humans
Male
Middle Aged
Patient Selection
Qualitative
Recruitment
Rehabilitation
SARS-CoV-2

Semantics

Type Source Name
drug DRUGBANK Etoperidone
disease IDO intervention
disease MESH COVID-19 pandemic
disease IDO role
disease IDO process
pathway REACTOME Reproduction
drug DRUGBANK L-Valine
drug DRUGBANK Trestolone
disease MESH stroke
disease IDO site
drug DRUGBANK Coenzyme M
drug DRUGBANK Methionine
drug DRUGBANK Spinosad
disease MESH heart failure
drug DRUGBANK Ranitidine
drug DRUGBANK Ademetionine
disease MESH uncertainty
drug DRUGBANK Methylergometrine
disease MESH multiple sclerosis
drug DRUGBANK Indoleacetic acid
drug DRUGBANK Elm
disease MESH mild cognitive impairment
disease MESH Dementia

Original Article

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