Background
Methods
Results
‘Situation normal’
We knew people in all of, we could have got (many) sites because we knew all the clinicians and surgeons working in various hospitals, so it was a matter of asking people whether they were interested in the study. [ … ] It was based on past research, and also, on reputation and people who you knew would probably be able to deliver with respect to pushing through recruitment. (CI 4)
So, I think the majority of the times, it’s the old boys network and who people know [ … ], so if I was doing another trial now, I’ve obviously got loads of experience of who can deliver and who can’t and we definitely would use that knowledge to work out who to invite to enter into another trial (CI 28).
Shifting the culture of site selection
Actively partner, nurture and trouble shoot in new high prevalence sites
[It was] a small District General Hospital that doesn’t take part in many studies … they were really enthusiastic because we sent them everything they needed. So, you know, all the participant information sheets we sort of localised for them. We sent […] everything they needed. They didn’t have to generate worksheets. They didn’t have to generate their own localised PIS [participant information sheets] because they’re not really experienced in doing these things, so we did everything for them and that’s what made the difference because they realised we were willing to put ourselves out for them. We made it easy for them. (CI 12)
I don’t believe in adding more sites. I think you, that’s a bit of a default response to poor recruitment, open more sites. Where actually you need to work out what’s going in the sites, I think. That’s where we tend to put our energy if there’s a problem. We don’t open more sites, we try to help the open sites to recruit better. You just end up going to the scene of the crime and finding out what they’re really doing. (CI 28)
Work with appropriate patient and public advisers in setting up the study
Ensuring that the PPIE contribution is relevant to the research setting, research question, and to populations most commonly affected by the condition may require accessing people who are seldom heard in research [18]. This may require extra effort (e.g. travel, training costs, working outside standard working hours) as well as consultation with community representatives and area specialists who can give pragmatic advice about aiding the appropriate PPIE contributors to come on board [19, 20].… patient representatives who often sit on the national committees, [ …] are very educated, very selected people and sometimes what we need is to have feedback from what I call ‘real life’ patients. [ …] We want to hear from, you know, the average X patient who’s often from deprived areas, you know, doesn’t always have great family support and so on and that is difficult to access. (CI 13)
Consider conducting qualitative research during study set up
we always use [ …] qualitative research investigation and we always request resources to be able to do that because that examines the, the recruiter’s perception, the patient perception and it improves, you know, you’re able to identify what these barriers are and then you’re able to fix them and you improve recruitment dramatically [ …] the interviews go to social medicine experts who will listen to the tapes, write transcripts, find out where the barriers are. Analyse them, come back to the recruiter, discuss with them how they talk to the patient. Whether they are sources of bias that could be eliminated. A very, very elaborate piece of work, but actually it makes or breaks recruitment. (CI 18)
Optimise use of research infrastructure
the sites, actually they were not aware that they could apply for resource from the local CRN, [ … ]. So, we actually had a, I don’t know if you call them roadshows, … … .you know, just to inform the potential sites of the facilities that are out there in the local network. As I say, if they could ask for additional resource, research resource particularly if obviously they were recruiting well. [ …] So, so a lot of it is actually about just organisation and management and being aware that [ …] there is the NIHR and there are research networks in each region and also informing them about their, certainly the [Speciality] CRN lead for that region who can help them with regards to any additional resource. (CI 29)
I would differentially reward recruitment in those areas, so rather than having one portfolio point per recruiter whatever it is, if it really is the North East who’s got the highest incidence and we’re recruiting there, it’s not going to be, I kind of feel they should get, you know, double the points, if you like, at least to a certain period of time until they get to a point where they’ve established how to do it. (CI 28)
Undoubtedly, you know, consultants need that protected time and if you don’t get it, particularly in busy DGHs (district general hospitals), the consultants just won’t be, won’t be able to engage in research. They’ll be pulled into clinical work, so funding for consultant time is, I think is paramount.” (CI 25)
Funder’s role in setting expectations
if there’s an imperative and it’s kind of insisted on by NIHR, people will budget accordingly and they will make allowances accordingly. But otherwise, I suspect most people will start with what they know and the places that they know” (CI 21)
Publicise examples of successful recruitment in new research sites in areas of higher patient need
“You speak to the patients and they’re all dead keen to take part, you know, because something needs to be done if it’s to help somebody else and there’s a lot of altruism going on with people from [location], you know, there’s a huge community spirit amongst these areas of deprivation.” CI 12