Brueton V C, Stevenson F, Vale C L, Stenning S P, Tierney J F, Harding S, Nazareth I, Meredith S, Rait G
MRC Clinical Trials Unit, UCL, London, UK.
BMJ Open. 2014 Jan 24;4(1):e003835. doi: 10.1136/bmjopen-2013-003835.
To explore the strategies used to improve retention in primary care randomised trials.
Qualitative in-depth interviews and thematic analysis.
29 UK primary care chief and principal investigators, trial managers and research nurses.
In-depth face-to-face interviews.
Primary care researchers use incentive and communication strategies to improve retention in trials, but were unsure of their effect. Small monetary incentives were used to increase response to postal questionnaires. Non-monetary incentives were used although there was scepticism about the impact of these on retention. Nurses routinely used telephone communication to encourage participants to return for trial follow-up. Trial managers used first class post, shorter questionnaires and improved questionnaire designs with the aim of improving questionnaire response. Interviewees thought an open trial design could lead to biased results and were negative about using behavioural strategies to improve retention. There was consensus among the interviewees that effective communication and rapport with participants, participant altruism, respect for participant's time, flexibility of trial personnel and appointment schedules and trial information improve retention. Interviewees noted particular challenges with retention in mental health trials and those involving teenagers.
The findings of this qualitative study have allowed us to reflect on research practice around retention and highlight a gap between such practice and current evidence. Interviewees describe acting from experience without evidence from the literature, which supports the use of small monetary incentives to improve the questionnaire response. No such evidence exists for non-monetary incentives or first class post, use of which may need reconsideration. An exploration of barriers and facilitators to retention in other research contexts may be justified.
探讨在初级保健随机试验中提高保留率所采用的策略。
定性深入访谈和主题分析。
29名英国初级保健首席和主要研究者、试验经理及研究护士。
深入面对面访谈。
初级保健研究人员采用激励和沟通策略来提高试验中的保留率，但不确定其效果。小额金钱激励用于提高对邮寄问卷的回应率。尽管对非金钱激励对保留率的影响存在怀疑，但仍被采用。护士常规使用电话沟通鼓励参与者返回进行试验随访。试验经理采用一等邮件、较短问卷以及改进问卷设计，目的是提高问卷回应率。受访者认为开放试验设计可能导致有偏差的结果，并且对使用行为策略提高保留率持否定态度。受访者一致认为与参与者进行有效的沟通和建立融洽关系、参与者的利他主义、尊重参与者的时间、试验人员和预约安排的灵活性以及试验信息可提高保留率。受访者指出在心理健康试验和涉及青少年的试验中，保留率方面存在特殊挑战。
这项定性研究的结果使我们能够反思围绕保留率的研究实践，并突出这种实践与当前证据之间的差距。受访者描述其行为基于经验而非文献证据，这支持使用小额金钱激励来提高问卷回应率。对于非金钱激励或一等邮件，不存在此类证据，其使用可能需要重新考虑。在其他研究背景下探索保留率的障碍和促进因素可能是合理的。
