Table 3.

Solutions to challenges in recruitment and retention of participants - Personal narrative and literature review[28,29]

Challenges	Solutions for recruitment	Solutions for retention
Trial design with stringent eligibility criteria and longer follow-ups	Sponsors and investigators  Early sponsor-investigator-other stakeholders’ meetings to draft a pragmatic protocol to address anticipated recruitment issues while writing a protocol  Piloting the study in few sites and learn from the experiences	Sponsors and investigators  Setting realistic targets (site recruitment targets, feedback, and competition among sites)  Options other than complete withdrawal  Patient and public involvement  Use of prescreening logs
Declining site performance due to insufficient resources	Sponsors  Develop site resources (e.g., giving necessary equipment to ease clinical trial conduct)  Dedicated sponsor help desk for queries  Disbursing funds to the site in a timely manner Investigators  Staff training about recruitment	Sponsors  Develop site resources  Staff training about retention
Poor patient contact	Investigators  IEC-approved newsletters, newspaper advertisements, scientific/educational presentations, patient support events, and community engagement, WhatsApp group notifications or other social media  Continuing contact with wait listed participants  Recruitment reminders (e-mail/CTMS alerts)	Sponsors and investigators  Additional contacts (reminders, newsletters, feedback for patients, websites calendars, and alert cards)
Patient inconvenience		Sponsors and investigators  Flexible appointments
Nonmotivated site staff or participants	Sponsors  Incentives (gifts for sites, co-authorship for good recruiters, and monetary incentives)  Recognizing site champions  Newsletters encouraging good sites	Sponsors  Incentives (gifts for sites, co-authorship for good retention, and monetary incentives)
Other factors	Investigators  Relationships (face-to-face initiation visit, regular contact with recruitment staff, and ongoing relationships between trials)	Investigators  Relationships (support for patient between visits, handwriting envelopes, festival/birthday cards, and thanking participants)

CTMS=Clinical Trial Management System, IEC = Institutional Ethics Committee