Schools as Sites for Recruiting Participants and Implementing Research

Abstract

Schoolscan be a valuable resourcefor recruitment of participants for research involving children, adolescents, and parents. Awareness of the benefits and challenges of working with schools canassist researchersin developing effective school partnerships.This articlediscusses theadvantagesof conducting research within the school system as well as the challenges that may also arise.Such challenges include developing key contacts, building relationships, logistical arrangements, and facilitating trust in the research topic and team. Suggestions for strategies to forge successful collaborative relationships with schoolsare provided.

Schools as Sites for Recruiting Participants and Implementing Research

Childhood and adolescence are very impressionable stages in development, making them ideal moments in which interventions can be initiatedto help students avoid risky behaviors. Primary and secondary schools have considerable power to influence child/adolescent decision making during these stages (Walsh, 2011). Intervening with adolescents in their school environment provides opportunities to directly influence the causes and consequences of behavioral health challenges (e.g. bullying, harassment, risky sex behaviors; Craig, Austin, & McInroy, 2014). School-based research may involve in-depth collaboration with a school, like when instructional time is used for the research, when the school helps define research aims,orwhen the school holds a vested interest in the project.The collaboration may also be less formal, as when the school simply provides a venue and access to student and parent participants. In these cases, the school approves the project, but school personnel are only minimally involved. This articlediscusses advantages and challenges in conducting research in schools and suggests strategies for building successful research collaborations with schools.

Advantages of Partnering with Schools

Collaborating withprimary and secondary schools (both public and private)to recruit participants and implementresearch is useful, especially whenthe populations of focus are school-age children and adolescents (Bartlett& Shelton, 2010; Hayes, Chapple, & Ramirez, 2014).The implementation of school-based research projectsmake it possible to obtaina number of diverse participants from atarget population(Alibali& Nathan, 2010; Mishna, Muskat,& Cook, 2012). School-based approachesmay result in better retention of child and adolescent participantsthan other methods, sinceschool attendanceismandatory. Engaging formal assistance from the school in recruitment may ease suspicions among student-family populations and improve participation. Potential participants maybe generally trusting of their schools; this trust may transfer to the research project, making recruitment even more successful (Bruzzese, Gallagher,McCann-Doyle, Reiss, & Wuetunga,2009). Including a member of the school staff to assist with recruitment may further enhance success,especially amongunderserved populations (Alibali& Nathan, 2010; Lamb, Puskar, & Tusaie-Mumford, 2001). Specifically, when conducting studies among special populations(like immigrants who may not have come into the country legally), these children and their families may perceive schools as ‘safe’spaces, since schools do not typically report immigration status to government officials. Researchers collaborating with schools may also have this safedesignation transferred to them and this could elicit participation from immigrants without fear of being reported to government agents.Of course, it is incumbent on researchers to adhere to all aspects of human subjects’ protections and informed consent in order to protect these vulnerable participants.

When research is conducted in the school immediately after school hours, school buildings/rooms can provide a venue or space for the research. Students are already at the study site, therefore transportation is needed only to return home. Schools may be incentivized to participate by providing some remuneration or a small fund for the collaboration. For funded projects, including this incentive in the budget is recommended (Bartlett& Shelton, 2010; Jago et al., 2011; Mishna et al., 2012).

Collaborating with schools has potential benefits not only for researchers but for the school and student participants. School-based interventions may benefit children and adolescents whose access to services is limited, including individuals from racial, ethnic, or religious minorities, and those marginalized by their sex status or sexual orientation. Studies involving adolescents from lower socioeconomic status (SES) backgrounds, for instance,mayofferguidance, structure, and support for these students(Craig et al., 2014; Curtis, McLellan, & Gabellini, 2014; Mishna et al., 2012). Many of these students may lack these advantages due to the time and resource constraints oftheir parents’ shift-work, single parent homes, or”latch-key” situations (Walsh, 2011). Intervention programs in schools are more accessible to adolescents than community-based programs (Curtis et al. 2014). An intervention conducted in a school may provide students access to education, treatment, or other programming to which they would otherwise lack access (Mishna et al., 2012).

Since adolescents may be more likely to visit a school-based health clinic than a community medical facility (Green et al., 2013), collaborating with a school health clinic mayprovide researchers access to a greater number of potential research participants. Of course, this would be dependent on the size of the school, number of students seen in the school-based clinic, and the availability of community clinics in the area. In some situations, and in our experience, because of similar interests, mutual trust, and logistical priorities, collaborating with a school-based health clinic may be even more efficient than collaborating with an individual school or school system, especially if interventions are health related. Also, when nurse researchers plan school-based research, gaining entry to a school can be enhanced by collaborating with the school-based health clinic, health educator, or school nurse.

Since children spend the majority of their daily lives at school, school-based research can allow for the observation of social interactions that naturally occur in a school setting (Alibali& Nathan, 2010). Conducting research in school environments may assistinvestigatorsin understandingspecific/targeted participant behaviors as well as intervening to address these behaviors (Mishna et al., 2012).

Challenges in Partnering with Schools

While there are many benefits to collaborating with schools for research, there are challenges as well. Researchers who anticipate and plan for managing these challenges can promote the opportunity for successful collaborations.

Logistics

A fundamental difficulty in conducting school-based research liesin the task of coordinating the numerous parties and levels of authority involved to gain entrance into a school or school system(Jago, et al., 2011;Mishna, et al., 2012; Powers, 2007). In order to gain access to the school and its resources, a researcher must begin to cultivate positive relationships with many school staff members (Powers, 2007). Gainingsupport and permission from leaders and personnel at different levels of the school system (i.e. staff, administration, school board) can be time consuming, costly, and may require extensive work on the part of the investigator (Mishna et al., 2012). The highest level of permission requiredvaries by school system. In some systems, the county superintendentmayneed to provide permission before other levels of permission are granted; in other cases, the community’s school board members may need to approve collaborations. Finding the appropriate contact person within private/charter schools may also be challengingand require significant investigation into the school administrative structure. Whatever the particular situation, it is important to identify the highest level of permission required,as early as possible in the process, to make efficient use of time and avoidconfusion.

After gathering vital information about the school(s) of interest and those who will grant approvals, a next necessary step would be to gain entry into the school itself. In our experience, having a connection within the school/school system facilitates access. Initiating the collaboration several months in advance of starting the project is necessary to gain this access and approval. Once a preliminary relationship is established, it is important to identify a member of the school staff to serve as a liaison or navigator to help with logistics and scheduling. Again, it is important to stress the length of time researchers may need to be in contact with this liaison so as to facilitate access to the school and its students. Approvals from schools and school systems may take an extensive amount of time, so the researcher should be prepared in the event progress is not made quickly.

Regardless of the level of involvement of the school, all research protocols have to be approved by an Institutional Review Board (IRB) and/or the school/district committees that may be in place. IRB approval not only protects human subjects but it is a requirement to disseminate research findings. Procurement of approval by research review committees affiliated with the school system may also be required. When a school system does not have its own research review committee, the investigator’s IRB may require a letter of approval from each collaborating site prior to its approval of a project. Obtaining the approval of research ethics committees may be an early and necessary step in the authorization process; however, those approvals do not guarantee access to a school or system. Further, obtaining multiple forms of approval (from the researchers’ institutional IRB and the school system’s approval boards or groups) adds complexity to the study and may involve additional time. Approval committees may require evidence of the benefits of a project to the school or system at the outset, they may want to review all survey instruments and materials to be used in the project, and they may require that a curriculum vitae or biosketch of each investigator be submitted. The complex approval process may affect the study timeline and/or protocol (e.g. getting approval just before the end of the school year; needing to obtain school administration’s approval of data collection instruments), so planning sufficient time to deal with various levels of approval and potential lack of approval is important.

Once entry to the school is gained, the researcher must meet the challenges of managing logistics associated with the school. Prior to initiating a study, researchers should take the necessary time and effort to obtain information on school scheduling, mandatory local and state school curricula, programs already offered by the school system, and a school or system’sopenness to specific intervention study topics.It is imperative to the research study to understand the daily operations of the school and the protocol of conducting research within a school setting, all while maintaining a productive working relationship with the school (White, 2012). Occasionally, perhaps to the detriment of the study, the team may find that school administrators allow data collection only during certain times and in certain places. Given these challenges, researchers must work together with school officials in order to maintain the collaborative relationship and continue conducting research. In addition, school sports schedules, teacher work days, end-of-grade testing, and closures due to weather conditions can affect all aspects of a study. If possible, it is helpful to obtain the school’s calendar of events prior to planning research-related activities to avoid major conflicts with other school activities.

Researchers must also face school-specific challenges. Lack of sufficient space for study activities, lack of resources, lack of trained research staff to aid in implementing interventions, and participant attrition are just a few of the concerns for researchers within an individual school setting (Mishna et al., 2012). If a research project is being conducted after school hours, research staff may experience interruption due to commonly used overhead paging systems or by interruptions from other after school events (i.e. social clubs, band practice, sports programs). It is critical that the researcher understand their status as a guest in the school, and work collaboratively with school personnel to reach solutions that meet the school’s needs and the needs of the research project.

Parental Involvement

Since children and adolescents are minors, and require parental consent to participate in research projects, an additional challenge of working in schools is the inability to reach parents of adolescents in order to approve their child’s participation (Jago et al., 2011). A lack of access to parentscan be discouraging, especially since the active engagement of parents in adolescent-focused intervention activities has been found to increase adolescents’ motivation and engagement in an intervention (Greca, Silverman,& Lochman, 2009; Lewis et al., 2009; Villarruel, Cherry, Ronis, Cabriales, & Zhou, 2008). Another obstacle identified by Coyne (2010) is the act of obtaining parental consent. An adolescent’s participation in a research study may be blocked due to the failure of a parent or legal guardian to give consent (Coyne, 2010). This situation occurs when an “opt-in” parental consent model is used, where potential participants are informed and consent is requested before participation occurs (Berry et al., 2011). However, this limitation can be alleviated by the use of an “opt-out” parental consent model, where potential participants are informed and included unless they express an unwillingness to participate (Berry et al., 2011).Prior researchhas utilized the opt-out consent method, indicating to participants the purpose of the research project, while explaining that they can withdraw their participation by submitting a provided form (Routh, Rao, & Denley, 2006). An opt-out parental consent model may not be appropriate for all projects, so the researcher must collaborate with the IRB to determine when and if this way of consenting could be used.

Challenges to conducting research within school settings also includes the lack of trust that investigators may encounter. Overcoming this challengecan take time and skill (Berry et al., 2013). Simply obtaining informed consent/assent from these parents and children may be difficult due to lack of trust and the challenges associated with access to them. In addition to gaining trust, there mayalso be language and cultural barriers that arise among parents that would need to be addressed accordingly. Having research staff members of the same race/ethnicity and who speak the same language as potential participants arestepsto begin to address these issues (Cabral & Smith, 2011; Wallace & Bartlett, 2013).

Scheduling can be another complex challenge to consider when conducting research studies within a school setting. Many scheduling concernsmust be considered when working with adolescents and their parents, including participation in conflicting afterschool activities, lack of transportation, and busy schedules of both the child and adult. It is of great importance to offer flexibility in scheduling to meet the needs of the participants. It may be helpful to obtain the school schedule while also having participants complete a calendar of scheduled events in order to plan research activities so as to avoid conflicts with other afterschool activities. It might also be that some potential participants should not be recruited to participate if their schedule is prohibitively full or complex. Reviewing the school activities calendar and scheduled community events provides clarity as to potential scheduling issues and ways to avoid conflicts that may affect recruitment, enrollment, attendance (White, 2012), and retention.

Topics of Study and Pre-established Programs

One factor that could affect the reception of a research program by a school or school system is the topic of study. Research related to sensitive topics (e.g. religious beliefs, drug and alcohol use, sexual practices/behaviors) may run counter to a school system’s mandate for what should be taught to students, as well as how and when it should be taught. For instance, if an individual school or school system has adopted an “abstinence only” curriculum, they may beless likely to allow a researcher to access their students for a safe-sex educational intervention than a school that operates under a harm-reduction approach to sex education. However, even in abstinence-only situations, the industrious researcher may discover that the school is willing to allow delivery of the “control” group portion of the program (as opposed to providing the actual safe sex education intervention). Therefore, knowing the existing philosophies, programs, allocations of authority, and opinions among administrators and parent-leaders can save a researcher time and effort.

Having a comprehensive understanding of the school, school system, and its curricula are necessary before beginning a research project within a school. Programs or curriculaalready in placemay influence entry into a school, access to participants,andaffectfindings of a research project. Many school districts have mandatory programs that are likely to overlap with topics addressed in behavior change interventions (i.e. sexual health, anti-drug, anti-bullying, anti-violence interventions; Cunningham, Cunningham, Ratcliffe, & Vaillancourt, 2010). Participation in research by students who are involved in other school behavior change programs may significantly affect the validity of research studies on these topics.For example, if a local school offers a comprehensive sex education program, a “safe sex” intervention will likely not have the same results as if the intervention took place in a school with an “abstinence only” sex education curriculum. At the very least, the research team should keep comprehensive field notes of information that emerges during the course of a study for use to understand and explain results later.

Measurement Obstacles

The manner in which data are collected can pose a challenge to school-based research projects. While self-report data are efficient and easy to use, this type of data collection has been criticized for the lack of accuracy and reliance on personal reflection (Lund, Blake, Ewing, & Banks, 2012; Mishna et al., 2012). Reliability can be particularly problematic when student self-report data arecollected by school staff members who are involved in a school-based intervention (Lund, et al., 2012).To avoid complications of self-report data, multiple data collection methods can be used, a neutral party on the research team can evaluate intervention results, and the team can be trained to communicate clearly with the school and students. At every data collection time point, researchers can also reiterate the team’s strategies used to promote both security and confidentiality of personal data. It is important to pilot test survey instruments and demographic questionnaires to assure that questions are easily interpretable by participants. Reading survey questions aloud helps to avoid issues related to literacy, and having clear instructions (via formal protocol) that are consistently provided to participants prior to data collection is important.

Additional Recommendations for Successful Collaborations with Schools

Management of Timeline

Many of the challenges to conducting research in schools can be overcome by researcher awareness and timely actions. Though cooperatingwiththe multiple levels of personnel involved in a study can be time-consuming and difficult, strategies can be implementedto keepthe process running smoothly. Prior to contacting a school, the researcher should allot time to gatherand learn as much information as possible about the system, the demographics of the area, and the school’s population. If a study focuses on a certain subpopulation of students, researchers must familiarize themselves with the general student demographics of that group (e.g., typical age, gender, race, ethnicity, income). This information can be found online in publicly available sites like School Report Cards or state or local education system descriptions. In addition, demographic information involving the setting (urban or rural) of a school can also be an important variable in research with some school systems including schools in both cities and rural areas.

Recruitment

Recruitment of individual participants and involvement of parents can be enhanced through a number of strategies. During recruitment, a member of the research team should explain the study and its benefits, address questions or concerns, and obtain contact information through the use of a sign-up sheet for those interested in private follow-up. Further, providing details about the study, with consent forms,may help facilitate conversations with parents/guardians and improve participation (Daley, 2013). Providing details about the study alongside consent forms, has been shown to facilitate conversations with parents/guardians prior to a study and to improve participation and retention rates (Berry et al., 2013). The researcher must be careful to fully inform potential participants about the study prior to obtaining consent. In our experience, participants may sign consents without reading them or having the consents read to them. To prevent this, a copy of the consent can be provided during the informed consent process that has no signature space. Once all information is provided and questions have been answered, the actual consent form with name fields can be provided to secure consent for those who wish to provide it.

To make participation in recruitment efforts more attractive, refreshments may be provided, and team members can be present to answer questions and provide guidance to participants, parents, and school personnel. Another strategy for recruitment is to promote or advertise the study at parent-teacher meetings. Research team members’ presence at these meetings reflects the school’s support for the project and allows potential participants and parents to learn about the project in a risk-free setting. Finally, hiring a community member to assist with recruitment can be another strategy to gain access to parents, depending on the sampling method used. If a pilot study was conducted in the same or a nearby community, hiring a parent who has already participated in the earlier arm of the project can be helpful in building trust among potential participants.

Having a school employee serve as a faculty sponsor or “navigator” in the school is a useful strategy to aid in recruitment. With permission of the school and approval by reviewing bodies, a school-based navigator or liaison can help identify and enable contact with potential participants. The presence of the navigator at recruitment meetings may demonstrate endorsement of the project, may build trust of students and parents withthe research team, and promote potential participants’willingness to enroll in the study.

To facilitate participation from vulnerable populations, and in order to foster trust between members of vulnerable underserved populations and research teams, researchers can provide accurate information, answer questions honestly, listen to all viewpoints, and strive to cultivate positive encounters (Berry et al., 2013). Friendly, responsive, and consistent interactions with research team members, who provide clear accounts of the study’s methods and aims, can enhance participation from these individuals (White, 2012). For groups of participants who may have illegally immigrated to the United States, researchers can emphasize the confidential nature of the study and if asked, assure potential participants that they have no communication with authorities regarding citizenship status.

Another way to meet the challenge of recruitment is to include culturally specific engagement strategies for adolescents from vulnerable populations. A study might choose to use recruiters and interventionists who reflect the target population in race and ethnicity and who are knowledgeable about likely cultural expectations and challenges for the group or area (Craig et al., 2014). Some suggested strategies for successful recruitment and retention of minority women and girl participants in research include being visible in the community prior to recruitment to build trust, being familiar with the community and recent events in the community, and holding meetings and events in convenient locations and at convenient times to decrease the time and travel burdens of participation (Wallace& Bartlett, 2013).

Logistics within the School Setting

Being flexible with research protocols is essential in school-based research (Alibali & Nathan, 2010). It is vital to understand that schools and teachers operate under numerous time constraints- a situation that requires patience on the part of researchers to allow ample time for a project to evolve, and discipline not to push too hard to achieve a desired timetable (Alibali & Nathan, 2010). Communication with school partners—early, frequent, and through multiple modes—allows better understanding of the how, when, and where of intervention sessions and data collection. The more flexible researchers can be, the more likely they are to have positive experiences working with schools (Alibali& Nathan, 2010).

Minimizing the use of school resources is also important and may include team members’ removing the trash or paying the custodian to clean up after recruitment or intervention sessions. Audiovisual or computer aids can be provided by the team, so that school equipment is not used. Every effort should be made to be respectful, patient, and collaborative with schools.

Streamlining study processes and carefully considering the potential impacts of research on a school are important to facilitate successful collaborations. Because schools are under increasing pressure from parents and governments to produce positive outcomes for students, researchers should avoid asking to use instructional time to conduct research (Alibali& Nathan, 2010; Jago et al., 2011; Powers, 2007). Indicating to school officials that the collaboration does not involve students’ instructional time greatly increases the chances of gaining a school’s involvement in research. Recruitment protocols and processes can be designed to avoid or decrease burdens on schools.

Summary

There are numerous positive aspects of partnering with schools for research. Schools offer access to difficult-to-reach populationsandprovide a convenient, single site for recruitment, intervention delivery, and data collection.Importantly, the school is a natural laboratory where many adolescent and childhood risk behaviors occur. School collaborations providenurseresearchers interesting in improving the health of communities with opportunities to understand behaviors in children and adolescents andsubsequentlydesign effective interventions. Research in schools may beespecially beneficial for student participants as well,for whom aspects of interventions, includingtargeted education,may be otherwise unavailable or difficult to access.

Challenges to conducting research in schools includemanaging the logistics of collaboration, obtaining access to participants within schools with parental consent, understanding how the topic of study may pose problems with intervention dissemination, and obstacles with measurements used. However, as we have illustrated, with careful planning and forethought many of these challenges can be overcome.

Building on experiences of working in communities, community health nurseresearchers can develop rewarding,collaborative relationships with schools, children, and parents in outcomes research. At their best, collaborative relationshipsfunction tobenefiteveryone involved. Nurses, schools, and other health and behavior professionals stand to gain from increased knowledge of student risk behaviors and responsivity to specific interventions. Schools and parents can benefit through their involvement in the planning and coordination of research. The children and adolescents themselvesbenefit directly and indirectly through access to education and programming provided through interventions, as well as frompotentially improved services in the long term. As we have outlined here, to meet thespecial challenges of school-based research and especially topromote valid findings that will add to knowledge and improve child and adolescent health, community health nurse researchers must consider their approach to collaboration with great care and planning.