Background
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Undertake an overview of systematic reviews of psychosocial determinants of research participation amongst patients and the public
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Summarise the reported determinants thematically and as barriers or facilitators
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Map these determinants to a behaviour change theoretical framework
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Map these determinants to interventions intended to increase participation in research.
Methods
Data sources and searches
Inclusion and exclusion criteria
Screening
Quality assessment
Data extraction and analysis
Results
Quality of the evidence
Author, year | Aim of review (as quoted) | Time frame of searches and date range of included studies | Population | Number of included studies (number in full review if different) Sample size Number of unique included studies | Included study design and data collection method | Subject of research participation | Location of included primary studies | AMSTAR score and category |
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Crane, 2017 [18] | The objective of this systematic review was to examine ethical issues surrounding research with children and adolescents from their perspective as participants | Time frame: dates not listed. Range: 2003–2014 | Children and adolescents, majority with physical or mental illness | 9 studies (23 in full review) N = 6326 Unique studies: 8 of 9 | Qualitative: 4 Quantitative: 3 Mixed methods: 2 Methods: interviews, focus groups | Any phase vaccine trials | Sweden: 2 USA: 7 | 5, medium |
Dhalla, 2013 [19] | The objective of this review article is to review barriers to participation in actual preventative HIV vaccine trials | Time frame: Cochrane Database for Systematic Reviews (no date), MEDLINE (1950–2012)/PubMed (no date), Embase (1980–2012), Google Scholar (no date). Range: 1994–2010. Range: 1995–2012 | Adults 8 studies involving low-risk adults 12 studies involving ‘higher risk’ adults (e.g. intravenous drug users, gay men, sex workers) | 20 studies N = 18,033 Unique studies: 8 of 20 | Qualitative: not reported Quantitative: not reported Methods: focus groups, questionnaires, mixed methods, spontaneous reporting | Any phase HIV vaccine trials | Canada: 1 Kenya: 1 Spain: 1 Tanzania: 2 Thailand: 4 UK: 1 USA: 8 Multiple countries: 1 Not reported: 1 | 7, medium |
Dhalla, 2014 [20] | The objective of this review article is to better understand motivators to participation in actual preventive HIV vaccine trials in terms of perceived social and personal benefits to such participation, as construed at these levels | Time frame: dates not listed. Range: 1997–2011 | Adults. 9 studies involving low-risk adults 5 studies involving ‘higher risk’ adults (e.g. intravenous drug users, gay men, sex workers) 6 studies involving a mix of high- and low-risk adults 1 study unknown risk | 21 studies N = 32,825 Unique studies: 11 of 21 | Qualitative: not reported Quantitative: not reported Methods: questionnaires, interviews, telephone hotline and focus groups | Any phase HIV vaccine trials | Canada: 1 Italy: 1 Spain: 1 Tanzania: 2 Thailand: 6 UK: 1 USA: 6 Multiple countries: 3 | 6, medium |
Fayter, 2007 [10] | Our aim was to undertake a systematic review of the relevant literature relating to the barriers, modifiers, and benefits involved in participating in RCTs of cancer therapies as perceived by health care providers and patients | Time frame: 1996–2004 Range: 1996–2004 | Patients (adults and children) diagnosed with various cancers | 37 studies (56 in full review) N = 25,788 (plus an unreported number from 4 studies) Unique studies: 23 of 37 | Qualitative: not reported Quantitative: not reported. Methods: surveys, focus groups, chart review, case controlled studies | Randomised controlled trials (excluding solely phase I or II) | Australia: 3 Canada: 1 Denmark: 1 Finland: 1 Italy: 1 Netherlands: 1 Sweden: 1 UK: 12 USA: 15 Multiple countries: 1 | 8, high |
Fisher, 2011 [21] | This review takes a different focus and considers the reasons that parents accept or decline an invitation to enrol children of any age in clinical research | Time frame: Scopus 1960 to Feb 2010; Web of Knowledge 1971 to Feb 2010 Range: 2001–2011 | Parents/caregivers of children invited to take part in research Two thirds of studies involved children with life-limiting or life-threatening conditions including cancer and diabetes | 16 studies N = 365 (plus an unreported number from one study) Unique studies: 10 of 16 | Qualitative: 16 Quantitative: 0 Methods: interviews, focus groups, ethnography, content analysis of websites | 14 trials, 2 unclear | Canada: 1 Gambia: 1 Malawi: 1 UK: 4 USA: 9 | 7, medium |
Forcina, 2018 [22] | We aimed to conduct a systematic review of studies limited to AYA patients which assessed attitudes and beliefs that influence cancer CT enrolment to prioritize areas for future study and intervention | Time frame: inception to May 2017 Range: 2009–2016 | Adolescent and young adult cancer patients aged 15–39 years | 6 studies N = 754 Unique studies: 4 of 6 | Qualitative: not reported Quantitative: not reported Methods: semi-structured interviews, questionnaires/surveys | Cancer clinical trials | USA: 1 Not reported: 5 | 6, medium |
Gad, 2018 [23] | We conducted a literature review to determine (1) the factors that influence [cancer] patients’ decisions to enter a phase I trial, (2) patients’ perceptions of the information they receive when they are invited to participate in a phase I trial and (3) relatives’ perceptions of the information given to patients | Time frame: inception to April 2017. Range: 1995–2014 | Adult patients diagnosed with various cancers | 15 studies (37 in full review) N = 1313 Unique studies: 10 of 15 | Qualitative: 4 Quantitative: 11 Methods: interviews, questionnaires, focus groups | Phase I trials | Canada: 1 Italy: 1 Japan: 2 UK: 3 USA: 8 | 10, high |
Glover, 2015 [24] | To our knowledge there have been no reviews that specifically focus on barriers or facilitators for Indigenous peoples’ participation in RCTs. This paper aims to address that knowledge gap by presenting the findings of a systematic review of the literature on challenges and facilitators of participation in health RCTs amongst Indigenous people from New Zealand, Australia, Canada and the USA | Time frame: inception to March 2012. Date range: 1994–2011 | 5 studies with Indigenous or Aboriginal Australians, 4 studies with First Nation participants, 6 studies with Maori participants, 31 studies with Native Americans or Alaskan Natives The majority (N = 11) focused on cancer, 7 on diabetes, 6 on substance abuse and 22 on other conditions/factors | 46 studies N = not reported Unique studies: 45 of 46 | Qualitative: not reported Quantitative: not reported Methods: not reported | Randomised controlled trials | Australia: 5 Canada: 4 New Zealand: 6 USA: 31 | 5, medium |
Grand, 2012 [25] | This review examines the relationship between the obstacles to participation in cancer clinical trials and accrual, focusing wherever possible on clinical trials in radiation oncology | Time frame: 1984 to 2009 Range: 1983–2007 | Patients diagnosed with various cancers | 20 studies (31 in full review) N = 13,681 Unique studies: 15 of 20 | Qualitative: not reported Quantitative: not reported Methods: questionnaires, interviews, surveys, review of patient/trial records, focus groups | Oncology clinical trials | Not reported | 5, medium |
Gregersen, 2019 [26] | To systematically review and thematically synthesise the experiences of patients and relatives when they have to decide whether or not to participate in a clinical oncology trial and to provide knowledge about the decision-making process | Time frame: dates not listed Range: 2000–2016 | Adult patients with advanced cancer | 11 studies N = 203 Unique studies: 4 of 11 | Qualitative: 11 Quantitative: 0 Methods: interviews, focus groups | Clinical trials | USA: 6 UK: 3 Japan: 1 Sweden: 1 | 5, medium |
Hughes-Morley, 2015 [27] | Our aims in undertaking this review were firstly to systematically identify relevant qualitative studies describing factors affecting recruitment of participants into depression trials; and secondly to perform a meta-synthesis to identify common themes that describe factors affecting recruitment into depression trials, to develop a conceptual framework of factors influencing the decision to participate in depression trials | Time frame: ASSIA 1987 to April 2013; CINAHL 1937 to April 2013; Embase 1974 to April 2013; MEDLINE 1946 to March 2013; PsychInfo 1806 to April 2013 Range: 2007–2012 | Patients with depression | 4 studies (15 in full review) N = 1034 Unique studies: 4 of 4 | Qualitative: 4 Quantitative: 0 Methods: questionnaire, interviews, focus groups | Randomised controlled trials | UK: 3 Multiple countries: 1 | 9, high |
Liljas, 2017 [28] | This systematic review aimed to identify facilitators, barriers and strategies for engaging ‘hard to reach’ older people in research on health promotion; the oldest old (≥ 80 years), older people from black and minority ethnic groups (BME) and older people living in deprived areas | Time frame: 1990 to 2014 Range: 1996–2014 | 18 studies of BME older people (aged over 50 years), 3 studies with oldest old patients (80 years and over) and 2 studies of older people in deprived areas | 23 studies N = not reported Unique studies: 23 of 23 | Qualitative: 12 Quantitative: 10 Mixed methods: 1 Methods: surveys, questionnaires, interviews, focus groups | Not reported. Studies focused on health promotion | Canada: 1 New Zealand: 1 UK: 4 USA: 17 | 7, medium |
Limkakeng, 2013a [29] | We carried out a systematic review of literature published between 1985 and 2009 to understand Chinese patients’ motivations and concerns to participate in clinical trials | Time frame: 1985–2009 Range: 2004–2008 | Chinese adults between 18 years and 85 years 1 study relating to HIV vaccine trials and 1 relating to cancer, 3 studies non-specific | 5 studies N = 645 Unique studies: 5 of 5 | Qualitative: 3 Quantitative: 2 Methods: surveys, interviews | Clinical trials | USA: 3 China: 1 Singapore: 1 | 8, high |
Limkakeng, 2013b [30] | The objective of this study was to conduct a systematic review and metasummary to evaluate what values, attitudes or beliefs on the part of potential or actual research participants with emergent medical conditions influence participation in research | Time frame: inception to 2011 Range: 2000–2009 | Adult patients aged over 18 years 5 studies focused on suspected myocardial infarction patients, 3 on stroke patients, 1 on sudden cardiac near-death survivors and 5 on other emergency patients | 14 studies N = 4003 (plus 1 study unclear) Unique studies: 12 of 14 | Qualitative: 6 Quantitative (survey): 8 Mixed methods: 3 Methods: surveys, interviews | Not reported. | Primarily conducted in American and Western European contexts Number not reported | 7, medium |
Martinsen, 2016 [31] | The aim of the current report was to perform a systematic review of the current literature on participation motives, response rates and recruitment strategies in research bronchoscopy studies with an emphasis on studies including COPD patients | Time frame: dates not listed Range: 1998–2013 | Patients with HIV, bronchoscopy patients, smokers, children with or without cystic fibrosis and parents | 6 studies (7 in full review) N = 455 Unique studies: 6 of 6 | Qualitative: not reported Quantitative: not reported Methods: interviews and questionnaires, focus groups, surveys | Not reported | The Netherlands: 1 UK: 3 USA: 1 Multiple countries: 1 | 5, medium |
McCann, 2007 [32] | The aim of this review was to draw together qualitative and quantitative studies reporting patients’ experiences of trial recruitment and participation to provide a broad-based overview of the literature | Time frame: 1996–2005 Range: 1982–2005 | Demographic data largely not reported. Range of trials including HIV, cancer, neonatal and myocardial infarction | 32 studies N = 6068 Unique studies: 21 of 32 | Qualitative: 12 Quantitative: 12 Mixed methods: 3 Systematic reviews: 5 Methods: interviews, questionnaires | Phase III trials | Denmark: 2 Europe: 1 Israel: 1 UK: 13 USA: 9 The Netherlands: 1 Multiple countries: 5 | 4, medium |
McCann, 2013 [33] | Update of 2007 review—no new objective stated | Time frame: September 2005 to December 2010 Range: 2006–2010 | Patients with a variety of conditions including cancer, epilepsy, stroke and pre-term labour. One paper discussed interviews with parents of children with leukaemia and 2 studies involved pregnant women or parents | 11 studies (12 in full review) N = 290 Unique studies: 9 of 11 | Qualitative: not reported Quantitative: not reported Methods: interviews, focus groups, observations | Randomised controlled trials | Australia: 1 Denmark: 1 UK: 7 USA: 1 Multiple countries: 1 | 7, medium |
Nalubega, 2015 [34] | This review aimed to synthesize and present the best available evidence in relation to HIV research participation in sub-Saharan Africa, based on the views and experiences of research participants | Time frame: inception to July 2013. Updated in September 2014 Range: 2004–2014 | All current or former adult HIV research participants from sub-Saharan African countries. 16 studies only involved women | 21 studies N = not reported Unique studies: 18 of 21 | Qualitative: 21 Quantitative: 0 Methods: focus groups, interviews, participant observation | Not reported | Kenya: 1 Malawi: 1 South Africa: 12 Tanzania: 4 Zimbabwe: 1 Multiple countries: 2 | 9, high |
Nielsen, 2019 [35] | The aim of this study was to examine cancer patients’ perceptions of factors that may influence their decisions on participation in phase I–III clinical drug trials | Time frame: 2010–2016 Range: 2010–2013 | Adult cancer patients | 9 studies N = 236 Unique studies: 3 of 9 | Qualitative: 9 Quantitative: 0 Methods: interviews, questionnaires | Cancer clinical drug trials | USA: 7 Japan: 1 Sweden: 1 | 5, medium |
Nievaard, 2004 [36] | To assess the factors that may influence a patient’s consent to participate in a clinical trial | Time frame: 1980 to April 2002 Range: 1984–2002 | Adult patients. 14 with cancer patients, 5 with HIV patients, 6 from other patient groups and 5 did not report the patient group | 30 studies N = not reported Unique studies: 19 of 30 | Qualitative: not reported Quantitative: not reported Methods: Not reported | 6 randomised controlled trials, others not reported | Australia: 3 USA: 14 Western Europe: 13 | 5, medium |
Nobile, 2013 [37] | The aim of this article is to review the literature addressing actual and apparently healthy participants’ reasons to enrol in biobank studies in order to see if some motives are unduly influencing the decision to participate | Time frame: inception to Jan to Feb 2012 Range: 2006–2012 | Healthy adult participants. 4 studies involved just women | 13 studies N = 1762 Unique studies: 12 of 13 | Qualitative: 9 Quantitative: 4 Methods: interviews, focus groups and surveys | Not reported. | Australia: 2 Europe: 1 UK: 3 USA: 7 | 5, medium |
Prescott, 1999 [38] | To assemble and classify a comprehensive bibliography of factors limiting the quality,number and progress of RCTs. To collate and report the findings, identifying areas where firm conclusions can be drawn, and identifying areas where further research is required | Time frame: 1986 to March 1996 Range: 1986–1996 | Majority of studies involved cancer patients (N = 9), 2 studies concerning child health involved parents/caregivers | 22 studies (27 studies in chapter) N = 15,295 Unique studies: 19 of 22 | Qualitative: not reported Quantitative: not reported Surveys, trial data, questionnaires, structured interviews | Clinical trials, not phase I or phase II | Australia: 1 Canada: 1 France: 3 The Netherlands: 1 UK: 5 USA: 11 | 8, high |
Quay, 2017 [39] | The aim was to identify barriers and facilitators to recruitment of South Asians to health research studies and associated strategies to improve participation | Time frame: January 2004 to April 2016 Range: 2004–2016 | South Asian patients. Majority of studies involved patients with a condition, e.g. asthma or diabetes | 10 studies (15 in full review) N = 3139 Unique studies: 8 of 10 | Qualitative: 9 Quantitative: 6 Methods: surveys, interviews, focus groups, literature reviews | 10 randomised controlled trials | Australia: 1 India: 1 UK: 7 USA: 1 | 8, high |
Tromp, 2016 [40] | This systematic review attempts to answer the following research question: What are motivating and discouraging factors for children and their parents to decide to participate in clinical drug research? | Time frame: inception to March 2013. Updated August 2014. Range: 1997–2013 | 26 studies involved parents or caregivers/guardians, 5 involved children and 11 involved both. Included children aged between 6 and 21 Diverse research population but many involved oncology patients (11 studies) 39 studies involved people who had consented, 24 involved people who had dissented. 29 studies involved treatments with prospect of direct benefit | 42 studies N = 5500 Unique studies: 33 of 42 | Qualitative: 16 Quantitative: 26 Methods: questionnaires, registry analysis, focus group, interviews | Not reported | Not reported | 7, medium |
Van der Zande, 2018 [41] | The objective of our paper was to identify and systematically review all articles regarding pregnant women’s reasons to participate in clinical research | Time frame: dates not listed Range: 2013–2016 | Pregnant/previously pregnant women | 30 studies N = 7905, plus an unreported number from 1 study Unique studies: 28 of 30 | Quantitative: not reported Qualitative: not reported Methods: interviews, focus groups, questionnaires, surveys, analysis of records | Observational studies and randomised controlled trials | UK: 10 USA: 7 Canada: 5 Australia: 2 China: 1 Ghana: 1 Ireland: 1 Italy: 1 Netherlands: 1 Pakistan: 1 | 5, medium |
Woodall, 2010 [42] | We aimed to review the current literature on the nature of barriers to participation across different mental health studies with a focus on whether there are specific gender-, age- and ethnicity-related barriers | Time frame: 1990 to 2008 Range 1992–2008 | Adult participants. 5 schizophrenia studies, 5 depression studies, 6 dementia studies and 5 where the illness was not specified | 16 studies (49 in full review) N = 2033, plus an unreported number from 9 studies Unique studies: 15 of 16 | Qualitative: not reported Quantitative: not reported Methods: surveys, interviews, recruitment | Not reported. | Australia: 1 Canada: 1 Germany: 1 Mexico: 1 Switzerland: 1 UK: 1 USA: 10 | 6, medium |
Characteristics of included studies
Identified psychosocial themes
Facilitators of research participation
Identified theme | Systematic reviews reporting the theme | Domain (components) of the TDF (from Cane et al., 2012) [14] | Interventions which probably affect recruitment to research (from Treweek et al., 2018) [8] | Interventions shown not to affect recruitment to research, or with uncertain effects (from Treweek et al., 2018) [8] |
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Facilitators | ||||
Personal benefit (including therapeutic benefits; closer monitoring; access to new treatments; gaining knowledge of own health) | Reported in 20 SRs: Dhalla, 2014; Fayter, 2007; Fisher, 2011; Forcina, 2018; Grand, 2012; Gregersen, 2019; Hughes-Morley, 2015; Liljas, 2017; Limkakeng, 2013a; Limkakeng, 2013b; McCann, 2007; McCann, 2013; Martinsen, 2016; Nalubega, 2015; Nielsen, 2019; Nievaard, 2004; Nobile, 2013; Quay, 2017; Tromp, 2016; van der Zande, 2018 | Optimism (Reflective Motivation) | Mentioning scarcity of trial places Positive framing of potential treatment benefits | Patient preference trial design |
Altruism (including benefits to science; helping others) | Reported in 18 SRs: Dhalla, 2014; Fayter 2007; Fisher 2011; Forcina, 2018; Gregersen, 2019; Hughes-Morley 2015; Limkakeng, 2013a; Limkakeng, 2013b; Martinsen, 2016; McCann, 2007; McCann, 2013; Nalubega, 2015; Nobile, 2013; Nielsen, 2019; Nievaard, 2004; Quay, 2017; Tromp, 2016; van der Zande, 2018 | Beliefs about consequences (Reflective Motivation) | ||
Confidence or trust in the physician or the research | Reported in 13 SRs: Crane, 2017; Grand, 2012; Gregersen, 2019; Hughes-Morley, 2015; Liljas, 2017; Limkakeng, 2013a; Limkakeng, 2013b; Martinsen, 2016; McCann, 2007; McCann, 2013; Nielsen, 2019; Nievaard, 2004; Nobile, 2013 | Reinforcement (Automatic Motivation) | Endorsements of previous participants | |
Low burden or convenient research | Reported in 4 SRs: Limkakeng, 2013a; Nobile, 2013; Tromp, 2016; van der Zande, 2018 | Belief about consequences (Reflective Motivation) Social or Professional Role & Identity (Reflective or Automatic Motivation) | Opt-out consent method | Two-stage randomisation method (may increase perceived inconvenience to the participant) |
Financial benefit or incentives | Reported in 3 SRs: Limkakeng, 2013a; Nalubega, 2015; Tromp, 2016 | Goals (Reflective Motivation) | Financial incentives | |
Barriers | ||||
Fear and perceived risk (to health, of experimental treatment or adverse effects; to personal consequences) | Reported in 14 SRs: Dhalla 2013; Forcina, 2018; Fisher 2011; Grand, 2012; Hughes-Morley, 2015; Martinsen, 2016; McCann, 2013; Nalubega, 2015; Nielsen, 2019; Nievaard, 2004; Quay, 2017; Tromp, 2016; van der Zande, 2018; Woodall, 2010 | Belief about consequences (Reflective Motivation) | Emphasising pain in information (−) | Emphasising risk in information |
Practical difficulties (including additional procedures or appointments; transport; costs; work or caring responsibilities) | Reported in 13 SRs: Fayter, 2007; Forcina, 2018; Glover, 2015; Grand, 2012; Hughes-Morley, 2015; Liljas, 2017; Martinsen, 2016; McCann, 2007; Prescott, 1999; Quay, 2017; Tromp, 2016; van Der Zande, 2018; Woodall, 2010 | Financial incentives Internet-based data collection (−) | Two-stage randomisation method (may increase practical demand) Email (not postal) invitations | |
Distrust of research or researchers (particularly amongst ethnic minorities) | Reported in 10 SRs: Glover, 2015; Hughes-Morley, 2015; Limkakeng, 2013a; Limkakeng, 2013b; McCann, 2007; Nalubega, 2015; Quay, 2017; Tromp, 2016; van der Zande, 2018; Woodall, 2010 | |||
Aversion to randomisation | Reported in 7 SRs: Forcina, 2018; Hughes-Morley, 2015; McCann, 2007; McCann, 2013; Nievaard, 2004; Tromp, 2016; van der Zande, 2018 | Environmental context and resources (Physical Opportunity) | Open trial design | Cluster trial design |
Treatment preferences (for specific therapy; against placebo) | Reported in 5 SRs: Fayter, 2007; Grand, 2012; McCann, 2007; Prescott, 1999; Tromp, 2016 | Reinforcement (Automatic Motivation) | Open trial design | Patient preference trial design |
Stigma associated with health condition | Reported in 5 SRs: Dhalla, 2013; Hughes-Morley, 2015; Nalubega, 2015; Woodall, 2010; Quay, 2017 | Social influences (Social Opportunity) | ||
Uncertainty (particularly in relation to trials; its links to randomisation) | Reported in 4 SRs: Fayter, 2007; Fisher 2011; Nievaard, 2004; Prescott, 1999 | Belief about consequences (Reflective Motivation) | Patient preference trial design | |
Personal health | Reported in 4 SRs: Hughes-Morley, 2015; Liljas, 2017; Limkakeng, 2013b; Woodall, 2010 | Emotion (Automatic Motivation) | ||
Desire for choice | Reported in 3 SRs: Grand 2012; Fisher 2011; Tromp 2016 | Goals (Reflective Motivation) | Patient preference trial design | |
Factors reported as facilitators and barriers | Belief about consequences (Reflective Motivation) | |||
Influence of physician, family or friends | Reported in 11 SRs: Fayter 2007; Forcina, 2018; Hughes-Morley, 2015; Gad 2018; Gregersen, 2019; Liljas, 2017; Limkakeng, 2013a; Nielsen, 2019; Prescott 1999; Tromp, 2016; van der Zande, 2018 | Belief about consequences (Reflective Motivation) | Endorsements of previous participants | |
Information quality and participant’s knowledge of the research | Reported in 5 SRs: Crane, 2017; Fayter 2007; Forcina, 2018; Glover, 2015; Gregerson, 2019 | Social influences (Social Opportunity) | Enclosing questionnaire on study method | Researcher reading out information (?) Easy-to-read consent form Optimising information through user testing or user feedback Brief patient information leaflet Providing information by phone Providing information by video (?) Providing audio record of recruitment discussion (?) Providing booklet on trial methods (?) Total or discretionary information disclosure (?) Educational package on study |