We have encountered barriers to health research caused by health system reforms. The PROMISE research programme on child and adolescent obesity was awarded £2.1 million in 2009 by the Department of Health's National Institute for Health Research. In one of the PROMISE projects, the Healthy Eating and Lifestyle Programme (HELP), a randomised controlled trial of a lifestyle intervention incorporating motivational and solution-focused techniques for 12–19 year-olds with obesity,1 we have faced significant difficulties with recruitment. While recruitment to obesity studies in adolescents is known to be challenging,2,3 we have encountered obstacles that we believe arise from changes in the NHS.
First, GPs have frequently been reluctant to help with recruitment into the study because of uncertainty over what kind of obesity services clinical commissioning groups may provide in the future. There has also been a reluctance to help because some participants would not get the HELP intervention because of randomisation. Indeed, in some regions where no obesity services exist, GPs have expressed a preference to provide nothing for all, rather than something for some, despite the context of useful research. We think that unwillingness to engage may represent concerns about future services, rather than reflect a limited understanding of the principles of research.
Second, the dissolution of primary care trust (PCT) structures during our recruitment phase meant that many PCTs refused or were unable to assist with recruitment, and pathways to obtaining local research permissions were often opaque due to local reorganisation.
Similar problems have been encountered in two other PROMISE studies. In our evaluation of the National Child Measurement Programme, participation by PCTs has been limited by future uncertainties. In another PROMISE study — developing and piloting an online tool for the assessment of overweight children in primary care — GPs have been reluctant to participate because of uncertainty surrounding future provision of services, as well as concerns about payments.
Obesity in childhood and adolescence is a key public health issue, yet little is known about how to treat it effectively. The Foresight report predicted that by 2050, 60% of males and 50% of females will be obese, costing the public around £50 billion per year.4 Obesity research for children and young people is important but now faces challenges from health system reforms. We would be interested to hear of similar experiences in obesity or other primary care research.
REFERENCES
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