Recruiting a Diverse Group of Middle School Girls into the Trial of Activity for Adolescent Girls

Article excerpt

Research efforts among children and adolescents in schools require careful attention to recruitment and retention rates. Recruiting students in school-based studies requires more than basic motivational efforts. One review of the literature (1) summarizes methods for maximizing student participation in school-based research into 3 processes: (1) communication, (2) logistics, and (3) incentives. Harrington et al (2) note that recruiting participants in school-based research requires a multilevel strategy directed at district, school, classroom, and individual levels. Direct contact with parents and strategies tailored to subpopulations add to the efficacy of recruitment activities. Additionally, the enlistment of an advocate at the district level, soliciting active support from teachers, and the use of incentives for both teachers and students all contribute to successful school-level recruitment efforts. Frye et al (3) found that specific classroom assignment was the strongest determinant of participation among fourth graders in a nutrition study, indicating that teacher enthusiasm for a study may drive participation.

Recruitment efforts can be affected, first and foremost, by the method of recruitment selected. Passive recruitment strategies assume parental consent unless investigators receive a signed refusal from parents, whereas active recruitment strategies require express written permission of the parent to allow the child to participate. According to Eaton et al, (4) active recruitment strategies can provide investigators with a definite indication of parental preferences that passive strategies cannot, but this is gained at the cost of greater monetary and temporal efforts. Minors or those below the age of 18 must also be given the opportunity to provide their permission, or assent, to participate. Given varying developmental stages, study information must be tailored to a child's developmental stage to obtain a valid informed assent. (5)

Research has shown that recruitment efforts are aided by the demonstration of caring on the part of professional staff, privacy and confidentiality, and altruism, as these characteristics increase the likelihood of study participation. (6) Coday et al (7) examined strategies among a 15-site National Institutes of Health (NIH) Behavior Change Consortium to determine the most effective retention techniques for various target populations enrolled in trials. While they found that a loss of interest in the study, scheduling conflicts, lack of time to participate, competing demands for time, and transportation issues posed as significant barriers, they also noted that adolescents and children, in particular, respond well to incentives as a recruitment and retention strategy.

According to Dickert and Grady, (8) as cited by Rice and Broome, (9) incentives can either be viewed as payment for the specific effort required for study participation, or as a financial reimbursement for expenses incurred by the child or family as a result of participation (eg, transportation). Nonmonetary incentives for youth in their preteen or teenage years include gift certificates, music CDs, tickets to concerts or other events, and movie passes. Rice and Broome (9) recommend that incentives for children be proportional to the effort required of them, and that separate incentives should be offered to parents. However, Scherer et al (10) caution that incentives may have a coercive effect as they found that the participants in their study of fair compensation for research trials actually suggested compensation in amounts less than what the researchers had proposed. Investigators therefore must balance the use of incentives to ensure that this compensation does not have a coercive effect on the participant, while also making certain that the incentive is relevant to the target population. (11)

Beyond incentives, study investigators must be flexible in their recruitment strategies to enable site-specific tailoring to meet the needs of potential participants and overcome unanticipated barriers. …