Table 5. The MISC: Challenges and responding strategies.
| Challenges | Responding strategies |
|---|---|
| Launching the cohort | |
| Underestimating number of staff required | Ongoing hiring and training |
| High turnover of research assistants | Supplementary training (time/cost implications) |
| Participant recruitment | |
| Concerns of study duration | Establishing nurse-liaison (maintain confidence and familiarity between involved parties) |
| Lack of interest | |
| Reluctance to enroll before obtaining husband’s approval | |
| Data collection | |
| Notification of delivery often overlooked | Daily tracking of participants approaching due dates |
| Same-day discharge, shortened post-delivery stays (limited time to collect information and samples at the hospital) | Providing the mothers with necessary supplies and instructions on sample collection at home and arranging a pick-up the next day |
| Milk supply is not fully developed | |
| Difficulty to provide milk with a pump | |
| Blood collection (especially from infants) | Recruiting specialized pediatric nurses |
| Technical difficulties/Parental refusal | |
| Quality assurance | Rigorous information system infrastructure Periodic data tracking and quality check Unanimous adaptation of pre-specified data collection and management protocols |
| Data collection using interviewer-administered questionnaire (resource-intensive) | Relocate additional cost |
| Participant retention | |
| Participant fatigue | Maximize participant convenience: Efficiency in data collection (challenging with multi-component questionnaires) Flexibility of data collectors to commute between study sites at convenient times for participants |
| Missed appointments and late arrivals | Reminders through direct communication at each data collection time-point |
| Lack of interest | Maintaining communication (phone calls/messages) Offering incentives Involve the husbands in research details and raise their awareness |
| Husbands’ reluctance | |
| Repeatedly missed appointments | Obtaining other contact detail information Repeated efforts for restoring communication Rescheduling the infant vaccination appointment to increase convenience to the mothers (within acceptable dates for vaccinations) Exclusion |
| Methodological considerations | |
| Potential unequal distribution of confounders and inherent dissimilarities between-groups | Collecting data relating to numerous potential confounders Careful control through statistical analyses |
| Potential differential loss to follow-up | Comparative analysis of baseline and last-observation characteristics between attired/retained participants |
| Limited ability to generalize the results to non-Arab residents | Priority of obtaining ethnic-specific data due to current lack of evidence |