Table 3.
Content analysis of recruitment facilitators (N = 184) and barriers (N = 69) from the included studies
| Theme | Domain | Category |
|---|---|---|
| Who (n = 28) | Recruitment Facilitators (n = 28) | |
| Medical provider (n=11) | “Champion” midwives, nurses, primary care provider, gynecologist | |
| Research study staff (n=8) | Research assistant, trained recruiter/interviewer | |
| Clinic staff (n=7) | Clinical staff, local ‘onsite’ staff, e.g., receptionist, office manager, nursing personnel | |
| Other (n=1) | Contract agency | |
| Recruitment Barriers (n = 1) | ||
| Medical provider (n=1) | Direct contact via physicians and midwives was relatively expensive and unsuccessful. | |
| Where (n = 48) | Recruitment Facilitators (n = 39) | |
| Clinic/hospital (n=30) | Prenatal visit/exam (n=11), on-site (unspecified; n=8), waiting room (n=5), routine blood collection/tests (n=2), hospital tour, satellite clinic, physician offices | |
| Community (n=6) | Public prenatal events, community classes, e.g., birthing, parenting and breastfeeding | |
| Prior studies (n=2) | Phone numbers on file, subset of existing longitudinal study | |
| Home (n=1) | Household-based recruitment | |
| Recruitment Barriers (n = 9) | ||
| Clinic (n=8) | Unregistered pregnant women, missed/cancelled/rescheduled visit, prenatal care bias, medical exam took priority, recruiters busy with other participants, clinical demands and priorities, lack of engagement | |
| Gated community (n=1) | Restricted access | |
| Direct Recruitment (n = 21) | Recruitment Facilitators (n = 21) | |
| Postal mail (n=9) | Targeted outreach by mail, multiple mailings, study leaflets included with screening results, personalized letters | |
| In-person (n=6) | Personal recruitment positively influenced initial enrollment, e.g., offering leaflets by research staff, gynecologists during medical exams, and in prenatal classes, community classes, clinics, hospital wards, and shops. | |
| Clinic (n=2) | Electronic health records, patient addresses and clinical schedules | |
| Door-to-door (n=2) | Targeted households | |
| Phone (n=2) | Phone response was higher when local staff made invitation calls. | |
| Indirect Recruitment (n = 31) | Recruitment Facilitators (n = 26) | |
| Posters/pamphlets (n=7) | Pharmacy, community, physician offices, clinics, hospitals, bookstores, childcare facilities, coffee shops, gym, in-person, etc | |
| Media (n=8) | TV, radio, newspapers, local news story, press releases, advocacy campaign | |
| Internet (n=4) | Facebook, Google AdWords, study website, articles on university websites | |
| Internet/social media (n=2) | Facebook, Google AdWords | |
| Paid advertising (n=3) | Billboards, advertising campaigns, internet, print advertising | |
| Branding (n=2) | Recognizable study brand, e.g., study logo, study website, baby T-shirts, refrigerator magnets, | |
| Recruitment Barriers (n = 5) | ||
| Internet/social media (n=2) | Social media bias, e.g., inequitable recruitment, costly w/o high return | |
| Awareness (n=2) | Poor public awareness of research, better advertising could lead to higher response rates | |
| Newspaper (n=1) | No detailed study information, time limited, e.g., only runs for one day | |
| Third-Party Recruitment (n = 23) | Recruitment Facilitators (n = 21) | |
| Outreach (n = 13) | Community outreach activities, e.g., press conferences, presentations, community events (e.g., information booths at “baby” trade shows and pregnancy fairs), leaflets at birth classes, charitable events; networking with pregnancy community; engagement of local stakeholders; links with community organizations; gaining trust and permission of “gatekeepers” such as apartment managers or homeowners’ boards, public health officials; prominent members of clinical community; public relations activities between research team and clinicians and community leaders; introduce study to hospital teams and encourage them to refer eligible women | |
| Partnerships (n = 5) | Advocacy campaigns with organizations, collaboration with ‘Moeders voor Moeders’ (Mothers for Mothers), community organizations, Department of Health and Human Services, Medicaid Managed Care Agency | |
| Word of mouth (n=3) | Study participants, friends, colleagues | |
| Recruitment Barriers (n = 2) | ||
| Partnership (n=1) | Time-consuming for researchers to establish those relationships | |
| Outreach (n=1) | Difficult to ascertain which strategies were most effective given idiosyncratic nature of community-based outreach. | |
| Contacting Participants (n = 14) | Recruitment Facilitators (n = 8) | |
| Phone (n=4) | Contacted within one week of visit, up to 10 contact times on different days at different times, contact women who did not initially consent or decline | |
| Internet (n=2) | Participants can contact study team via web-based Facebook page. Study team can use email to follow-up and make procedures more efficient with participants. | |
| Text (n=1) | No fee for texting | |
| Multiple contacts (n=1) | Provide home, cell, and work telephone numbers and the name and telephone number of one relative or friend who did not live with them. | |
| Recruitment Barriers (n = 6) | ||
| Internet (n=5) | Selection bias due to self-selection and/or access, lack of access, inability or problems with using the internet, lack of physical contact with participants, (e.g., collection of biological specimens), issues of privacy | |
| Staff (n=1) | Not having adequate staff coverage to contact as high proportion of eligible women as possible | |
| Participant Factors (n = 58) | Recruitment Facilitators (n = 22) | |
| Motivators (n=16) | Helping others, helping oneself, contributing to science/research, prior participation in research, convenience, staying within one’s comfort zone, physician’s endorsement, personal relevance to the topic, high regard for academic universities/hospitals, incentives and participation, early in pregnancy, “give back” | |
| Considerations (n=6) | Work-life balance, ethics, reputation of research institution, interpersonal skills of researcher, trust in research team/institution, accessibility | |
| Recruitment Barriers (n = 36) | ||
| Reasons for refusal (n=25) | Bio-intensive protocol, participant burden, unwilling to consent, concerns of confidentiality, religious beliefs, stress in pregnancy, not interested, no permission from mother or husband, invasive, sensitive topics, child development assessments, problems using internet | |
| Other barriers (n=11) | Transportation, less certain about allowing their children to participate in future research, more educated women appeared more cautious regarding collection of biospecimen data, lack of familiarity with research, misconceptions about research, influenza epidemic, distrust of study team, unmet basic needs, preoccupied with needs of the baby, inconvenience, type of data collected | |
| Cultural Considerations (n = 29) | Recruitment Facilitators (n = 19) | |
| Multilingual staff (n=7) | Interpreters, bilingual recruiters and interviewers, team fluency in key community languages, bilingual research staff in clinical offices, interviewer-administered questionnaire | |
| Multilingual materials (n=6) | Translating recruitment materials, study documents, data collection instruments | |
| Low-income, minority women (n=3) | Diverse community engagement strategies, personal recruitment techniques, e.g., face-to-face, financial incentives | |
| Cultural sensitivity (n=2) | Sensitive to culturally specific practices, cultural norms, and religious practices; adapting research design and implementation strategies to minimize cultural differences, matching recruiters by race/ethnicity | |
| Trust (n=1) | “Development of trust and confidence between the participant and the researcher is the key to the success of a clinical and epidemiological study involving ethnic minorities (Neelotpol, 2016).” | |
| Recruitment Barriers (n = 10) | ||
| Lack of trust (n=4) | Immigrant communities, reserved about research, conservativeness, e.g., not able to get permission from other family members to participate, mistrust of government and health providers | |
| Language (n=3) | No bilingual research staff, translation/interpreter costs | |
| Cultural sensitivity (n=3) | Perceived stereotypes sustaining cultural myths held by researchers; failure of recruiters to acknowledge important values, discrepant views between potential participants and researchers | |