Recruit, recruit, recruit … but don’t forget retention!
Researchers often put considerable effort into planning how they will recruit participants to their research but much less effort is put into planning strategies to promote retention. Having one without the other will often have an impact on the conduct of the research and might even be described as unethical if researchers’ and participants’ time is to be wasted by poorly planned research and retention strategies.
As a Research Ethics Committee (REC) Chair, I know that the one of the commonest protocol amendments is requested to manage deficiencies in recruitment and retention. This will sometimes be the result of Lasagna’s Law, or other unanticipated problems, but there will also be occasions when participant attrition has contributed to incomplete data and the need to extend recruitment.
Rates of attrition have been reported as ranging from less that 1% to as much as 48%. These rates of attrition are clearly dependent on the type of research, the nature of the intervention, the burden on participants and the duration of study participation. There is also research suggesting that culture, age, income and education have an impact on attrition. Whatever the causes, attrition can have an immense impact on the conduct of a clinical trial and the quality of the data being collected. Extending a study will have additional costs and could delay the development of potential new treatments. The impact on the motivation of existing participants and the morale of researchers should also not be underestimated.
So while it remains important that researchers continue to focus on strategies to promote recruitment, they might also enhance their research if they also spent more time considering strategies to encourage participant retention. Options might include:
- Convenience. Every effort should be made to make participating in a clinical trial as easy as possible. Can data collection be undertaken in the participant’s home or can the next follow-up visit be scheduled to coincide with a routine clinical visit?
- Reminders. Many researchers already use different strategies to remind participants about upcoming follow-up visits but how often are these tailored to the participants? One size does not always fit all.
- Updates. Research participants have given their time and often like to know how research is progressing. Providing updates, perhaps through regular newsletters, might help maintain motivation to continue participation when it might feel easier to withdraw from a research study. Research participants are more likely to continue their engagement with research if they believe they have some ownership of the research.
- Online community. We now use social media in so many different ways to share what we are doing so why not create online communities of research participants? These could again motivate participants to continue their participation.
- Financial reimbursement. Whenever possible, participants in research should be reimbursed for any travel costs and, when appropriate, other costs … creating a whole different debate I don’t intend to go into in this blog.
Researchers who fail to consider how they might improve retention and reduce attrition when planning their research are neglecting an important aspect of their research design. Perhaps the number of protocol amendments submitted to rectify inadequate recruitment and retention would fall if the rates of attrition in clinical trials were also to fall. Recruit, recruit, recruit … but don’t forget retention.
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