Recruitment staff discussed many influences, which were out of their control, but affected women’s ability to engage with the project, either positively or negatively. These external impacts can be depicted as environmental or specific to the woman. Firstly, a leading topic related to the waiting room environment. Larger clinics tended to be extremely busy, making it difficult for quiet private conversations. Often there would not be any empty seats next to eligible women and sometimes women sat on the floor while waiting for their appointments. This hindered recruitment efforts considerably because recruiters were conscious of the
lack of privacy when talking to women about a potentially sensitive topic. Some clinics provided private rooms for recruiters, which was extremely useful in overcoming these issues.
“The room doesn’t have enough seats a lot of the time for the ladies to sit down. Sometimes I found, even just to be able to talk to the ladies, I’d be squatting down on the floor next to them, while they were on a seat, or we’d be standing up over against a wall. So, it was really difficult.” [Midwife 2]
“We’d go out and call the women’s names and there would be pregnant women sitting on the floor. There was not enough seats, not even enough seats for us to actually sit down and get to the same level of the women we’re recruiting.” [Midwife 3]
Secondly,
support by clinical and administrative staff was crucial to success in engaging women with the research. On occasion, recruitment staff felt they were a nuisance, adding to the busy clinical workload, although more often, reception staff assisted recruiters to identify eligible women from their booking lists and clinical midwives introduced the recruiter during antenatal visits. This legitimised the presence of the recruiters, which in turn increased the engagement of women.
“The midwives were actually really helpful. A couple of midwives here and there, they weren’t that helpful, But [mostly] they were saying for instance; ‘have you heard about this study? [Midwife 4] going to talk to you after.” [Midwife 4]
“Most of the time the midwives were too busy. We were sort of hoping they would help us initially, but it was clear quite early that they were really busy and that they didn’t have time to come and tell us that, or identify any [eligible women] to us.” [Midwife 3]
Next, if women were called into their appointments with little waiting time, or while talking to recruiters, it was difficult to complete recruitment as women could be difficult to locate afterwards or recruiters would then be in conversation with another potential participant. This
time factor proved a substantial issue, which could not be addressed as it was intrinsic to how the clinics operated.
“Frequently they would arrive, sit down and would be called in straight-away, which meant that our window wasn’t open.” [Other professional 2]
“Time was always an issue, because the first appointment takes about an hour. So, completing the questionnaire meant doing it before or after, and 5 minutes of recruitment is 5 minutes that you really don’t have.” [Midwife 4]
Secondly, recruiters talked about how
distractions such as the presence of small children sometimes changed how women engaged with their approach. Sometimes women needed to attend to their toddlers, taking up their available attention.
“I think some of the ones who had toddlers, they probably would’ve been interested if they weren’t so busy with another child. That was probably quite a common reason I got; ‘Look I’m really busy at the moment’”. [Midwife 2]
“I don’t think there have been any that have been really difficult to approach, other than the ones that are very distracted with little kids.” [Other professional 1]
Other times, when partners were present, their opinion occasionally differed from the woman’s, which quickly ended any conversation about taking part in the research.
“Once again, you picked up the non-verbal body language that the partner was not impressed and didn’t want his wife or partner being part of a study regarding alcohol… The way they sat, particularly the men, I would say their body language became a bit assertive. They’d either sit forward on their seat or some of them would initially engage, as in eye to eye contact but then they’d sit back in their chair and not engage the eye to eye contact.” [Midwife 1]
“I did get the feeling that there were a few ladies who would have participated, but didn’t, because their husbands or fathers didn’t want them to.” [Midwife 5]