By Julia Rybkina
Research recruitment can be a lot like dating: there is a large variety of potential participants and studies in the sea, but the challenge lies in finding perfect matches in a timely manner, using the most effective methods. Enrolling the intended number of participants is essential to the success of a study and its “procreation” (i.e., obtaining meaningful findings, publishing in reputable journals, and creating follow-up studies).
However, recent findings show that approximately one third of clinical trials fail to meet 100 per cent of participant enrollment goals. Insufficient recruitment, in turn, can result in study termination or delays, increased costs, and deprivation of the chance for individuals to potentially benefit from life-saving interventions or aids (1-3).
Understandably, it is no easy feat to ask individuals who experience complex, life-altering conditions to share their time and knowledge for the sake of scientific investigation. Yet research is undeniably important and has a significant impact on the evolution and betterment of clinical care.
In this article, we discuss some of the common challenges that rehabilitation researchers face with participant recruitment. Novel approaches to recruitment via social media platforms, like Facebook and Twitter, are introduced, with the hope of inspiring researchers and participants alike to use such modes and “get out there” for more successful and efficient matchmaking.
Getting Out There: The Importance of Research Recruitment and Participation
Rehabilitation (or “rehab” for short) holds an important role within the Canadian healthcare continuum as our population grows older and the demand for services rises (4,5). Rehab research is the primary way of developing novel or improved assessment tools, indicators, technologies, and interventions. Rehab research also helps professionals provide effective care and facilitate their clients’ goals (6). For researchers, effective recruitment results in faster and more cost-effective study completion, and a greater likelihood of knowledge sharing and integration in practice and/or the community (7).
Partaking in research provides an equally valuable opportunity for participants. It can encourage them to have a voice in their care, feel empowered, and contribute meaningfully to the improvement of rehab services for current and future generations (8).
Participation in rehab research has also been associated with personal benefits for patients, by developing greater knowledge of their condition, nurturing their sense of agency, helping them find a community, and possibly deterring some negative consequences of disability such as social withdrawal and associated mood disorders (7,8).
Hence, like any healthy relationship, research aims to benefit and bring out the best in both parties. Unfortunately, healthy relationships can be elusive.
Forever Alone: Known Barriers to Effective Recruitment
The reasons for poor research recruitment are numerous and multifaceted. Potential participants approached about getting involved in research are often affected by emotionally- and physically-debilitating conditions such as stroke, multiple sclerosis, brain and spinal cord injuries, and/or age-related conditions such as dementia and heart disease. These are commonly associated with impaired communication, mental and physical function, and emotional fatigue, making recruitment particularly challenging (9). For instance, approximately half of stroke patients have cognitive and physical impairments that persist for years (10).
Practical and ethical issues are raised when recruiting these individuals, such as recognizing and assessing the extent of the impairment, interpreting the patient’s preferred method of communication, and finding an appropriate accommodation (2,9). In contrast, individuals with sudden spinal cord injury or brain injury need time to adjust before they can consider research participation meaningfully. Therefore, such circumstances delay study recruitment and in extreme cases, may result in individuals being left out of the research process altogether.
To improve recruitment, some researchers suggest increasing available resources by building closer relationships with patient’s care team (e.g., nurses, physiotherapists, and social workers) (11-13) and implementing more accessible recruitment procedures (e.g., recruiting via the telephone to minimize travel) (12).
Furthermore, where possible, it is important for rehab researchers to practice reflexivity―that is, to review the study’s design continuously and make appropriate changes from participant feedback. This reflexivity can ensure that the process is not burdensome, and instead easy for the participant to understand.
Match at First Sight: Recruiting via Social Media
Most rehabilitation research studies rely on traditional methods to recruit participants, through advertisements (e.g., flyers, newspapers, radio, television, online platforms), letters or emails to specific patient groups, or word of mouth. However, these traditional methods are often hampered by financial and time costs. With the recent popularization of social media, an opportunity arises to use it as a novel resource and potentially transcend some long-standing limitations.
For instance, a recent study showed that recruitment via Facebook was faster and cheaper than traditional methods and facilitated access to hard-to-reach demographic groups, such as youth (14). A study on Twitter―a platform intended for more open, widespread conversation than Facebook―found it to be particularly effective in increasing recruitment reach, thanks to the platform’s “retweeting” and “sharing” options (15). Additionally, social media appears to be effective when recruiting an international, multi-disciplinary sample because it transcends geographical distance and language barriers (16).
Hence, researchers should consider social media as a potentially better alternative to traditional recruitment methods. Since social media is fast, cheap, easy to use, and can have far reach, it may help rehab researchers engage with target populations more effectively―and in turn, help potential participants find studies of interest.
While promising, as a word of caution, it is important to be mindful of ethical policies and guidelines that research institutions may have on social media use, including any biases (e.g., favouring younger, technologically-savvy participants) that may be introduced.
Research recruitment in the field of rehab is critical for study success, scientific progress, and betterment of care. Though recruitment is challenging, due to limited resources and the nature of participants’ conditions (much like the dating scene), the process is undergoing a transformation to using more modern methods to finding their match: as technology users grow in numbers and millennials age, social media may be the future in research recruitment.
This new approach might make finding “the one” (participant or study) easier, so you can say “thank you, next!” to recruitment struggles.
To refer to this article, it can be cited as:
Rybkina J. Research recruitment struggles? Thank you, next. rehabINK. 2019;6. Available from: https://rehabinkmag.com
- Gul RB, Ali PA. Clinical trials: the challenge of recruitment and retention of participants. Journal of Clinical Nursing. 2010;19:227-33.
- Tyson SF, Thomas N, Vail A, Tyrrell P. Recruiting to inpatient-based rehabilitation trials: lessons learned. Trials. 2015;16.
- Blackmer J. The unique ethical challenges of conducting research in the rehabilitation medicine population. BMC Medical Ethics. 2003;4:2.
- Statistics Canada. 2005-2031 Population projections for Canada, Provinces and Territories. [Internet]. 2005 [cited 2018 Nov 10]. Available from: https://www150.statcan.gc.ca/n1/en/pub/91-520-x/91-520-x2005001-eng.pdf?st=TTIFXdJI
- Landry MD. Availability and access to rehabilitation services along Ontario’s continuum of care. 2009 [cited 2018 Nov 10]. Available from: http://www.realizecanada.org/wp-content/uploads/PamphletPolicyBriefAvailabilityOct15.pdf
- Canadian Institutes of Health Research.Rehabilitation science – quality of life through independent living. 2007 [cited 2018 Nov 13]. Available from http://www.cihr-irsc.gc.ca/e/11200.html
- Ommaya AK, Adams KM, Allman RM, Collins EG, Cooper RA, Dixon CE, et al. Opportunities in rehabilitation research. Journal of Rehabilitation Research & Development. 2013;50:vii-xxxii.
- Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, Brito JP, Boehmer K, Hasan R, Firwana B, Erwin P. Patient engagement in research: a systematic review. BMC Health Services Research. 2014;14(1):89.
- Campbell GB, Skidmore ER, Whyte EM, Matthews JT. Overcoming practical challenges to conducting clinical research in the inpatient stroke rehabilitation setting. Topics in Stroke Rehabilitation. 2015;22(5):386-394.
- McInnes K, Friesen CL, MacKenzie DE, Westwood DA, Boe SG. Mild traumatic brain injury (mTBI) and chronic cognitive impairment: scoping review. PLoS One. 2017;12(4):e0174847.
- Newington L, Metcalfe A. Factors influencing recruitment to research: qualitative study of the experiences and perceptions of research teams. BMC Medical Research Methodology. 2014;14:10.
- Carlisle B, Kimmelman J, Ramsay T, MacKinnon N. Unsuccessful trial accrual and human subjects protections: an empirical analysis of recently closed trials. Clinical Trials. 2015;12(1):77-83.
- Turolla A, Dam M, Ventura L, Tonin P, Agostini M, Zucconi C, et al. Virtual reality for the rehabilitation of the upper limb motor function after stroke: a prospective controlled trial. Journal of Neuroengineering & Rehabilitation. 2013;10:85-85.
- Whitaker C, Stevelink S, Fear N. The use of facebook in recruiting participants for health research purposes: a systematic review. Journal of Medical Internet Research. 2017;19:e290.
- Wasilewski MB, Stinson JN, Webster F, Cameron JI. Using twitter to recruit participants for health research: an example from a caregiving study. Health Informatics Journal. 2018;1-13.
- McRobert C, Hill JC, Smale T, Hay E, van der Windt DA. A multi-modal recruitment strategy using social media and internet-mediated methods to recruit a multidisciplinary, international sample of clinicians to an online research study. PLoS One. 2018;13:e0200184.