Establishing Requirements for Technology to Support Clinical Trial Retention: Systematic Scoping Review and Analysis Using Self-determination Theory

Retention in the Bukhali trial in Soweto, South Africa: a qualitative analysis using self-determination theory

INTRODUCTION

There is limited research on applying theory to retention in complex intervention trials. To address this gap, this study aimed to qualitatively examine retention in the Bukhali randomised controlled trial, from the perspective of trial participants and staff, through the lens of self-determination theory (SDT). The Bukhali trial is part of the Healthy Life Trajectories Initiative in Soweto, South Africa, with young women.

METHODS

Nine focus group discussions were used to generate data from Bukhali trial staff (n=45, 23-64 years), and participants, including those currently enrolled (n=16, 25-31 years) and those who had withdrawn from the trial (n=20, 24-32 years). A codebook thematic approach was taken to data analysis; SDT was used to develop a conceptual model to analyse the data in context. The main themes identified were external influences on the trial, trial implementing environment, controlled motivation and intrinsic autonomous motivation.

RESULTS

Our findings highlighted the contextual issues influencing the trial, including participants' socioeconomic circumstances, and the presence or absence of social support, the trial complexity and participant burden. Issues related to controlled motivation comprised challenges of staying in contact, financial incentives and food, health services provided and other incentives. We also identified aspects of the trial supporting participants' psychological needs of autonomy, competence and relatedness, which in turn contributed to their intrinsic autonomous motivation. These included participants' interest in the trial and its relevance to them; participants' sense of agency, meaning and purpose through their involvement; the building of their knowledge and awareness about their health; relating to other participants and the relationships built with staff and being treated well.

CONCLUSION

SDT provides a helpful frame for a contextualised understanding of the complexity of retention of Bukhali trial participants (longitudinal study and intervention). These findings have relevance for trials in under-resourced settings.

Comparison on self-determination, peer-relationship, and alienation in physical education of early adolescent in Korea and China

Introduction

In order to identify effective strategies for enhancing a high-quality physical education system, it is imperative to undertake research that examines the nuances of educational culture, specifically focusing on the psychological experiences of early adolescents within physical education classes. This study aims to compare self-determination, peer-relationships, and feelings of alienation in physical education among adolescents from Korea and China, both situated in East Asia, with respect to their nationality and gender.

Methods

One hundred and twenty two early adolescent males (M = 14.34, SD = 0.65) and 78 females (M = 14.34, SD = 0.64) from South Korea and 125 early adolescent males (M = 14.13, SD = 0.58) and 70 females (M = 14.13, SD = 0.59) from China participated in this study, with a mean age of 14.24 ± 0.62. The Academic Self-Regulatory Scale (SRQ-A), Peer-relationship Questionnaire, and a Scale for Measuring Student Alienation in Physical Education were utilized for data analysis. For statistic comparisons, a t-test was used.

Results

Self-determination of male and female students in China was significantly higher than that of male and female students in Korea, respectively. Peer-relationship of male students in Korea was significantly higher than that of male students in China. Physical education alienation of the female students in Korea was significantly higher than that of male students in Korea.

Discussion

Given that the influence of self-determination, peer relationships, and physical education alienation varies by nationality and gender, it is crucial to seek and implement strategies to develop an effective physical education system. By doing so, physical education alienation can be minimized and prevented, ultimately preserving the health and well-being of adolescents. This approach is vital for fostering a supportive and inclusive environment that promotes lifelong fitness and health.

Recruitment and Retention Strategies for Historically Marginalized Populations in Colorectal Cancer Trials: A Cross-Sectional Analysis Using Systematic Review Methods

PURPOSE

Colorectal cancer (CRC), a leading cause of cancer mortality, disproportionately impacts historically marginalized populations due to persistent health inequities. Effective recruitment and retention strategies are crucial to improving the representation of these populations in clinical trials. This study aims to evaluate the use of recruitment and retention strategies in CRC clinical trials, their impact on participant diversity, and the presence of diversity recruitment goals and ethical considerations.

METHODS

We conducted a cross-sectional analysis of CRC treatment trials following PRISMA guidelines. Eligible studies were assessed for recruitment and retention strategies, diversity recruitment goals, and ethical considerations. Data were extracted in duplicate, ensuring masked and independent evaluations.

RESULTS

Of the 2563 records identified, 55 studies met the inclusion criteria. Most trials (83.6%) focused on therapeutic interventions, and government funding was the most common (38.2%). Only three studies (5.5%) reported strategies to recruit historically marginalized populations, and 54 studies (98.2%) lacked diversity recruitment goals. None of the trials discussed ethical considerations related to diverse recruitment.

CONCLUSION

This study highlights significant gaps in recruitment and retention strategies for historically marginalized populations in CRC clinical trials. Few studies implement strategies to address these disparities which affect the diversity of the trial population, underscoring the need for targeted efforts to improve trial inclusivity. Addressing these gaps is critical to ensuring more equitable and representative outcomes in CRC research.

Leveraging oncology collaborative networks and biomedical informatics data resources to rapidly recruit and enroll rural residents into oncology quality of life clinical trials

Purpose

This study assesses the feasibility of biomedical informatics resources for efficient recruitment of rural residents with cancer to a clinical trial of a quality-of-life (QOL) mobile app. These resources have the potential to reduce costly, time-consuming, in-person recruitment methods.

Methods

A cohort was identified from the electronic health record data repository and cross-referenced with patients who consented to additional research contact. Rural-urban commuting area codes were computed to identify rurality. Potential participants were emailed study details, screening questions, and an e-consent link via REDCap. Consented individuals received baseline questionnaires automatically. A sample minimum of n = 80 [n = 40 care as usual (CAU) n = 40 mobile app intervention] was needed.

Results

N = 1298 potential participants (n = 365 CAU; n = 833 intervention) were screened for eligibility. For CAU, 68 consented, 67 completed baseline questionnaires, and 54 completed follow-up questionnaires. For intervention, 100 consented, 97 completed baseline questionnaires, and 58 completed follow-up questionnaires. The CAU/intervention reached 82.5%/122.5% of the enrollment target within 2 days. Recruitment and retention rates were 15.3% and 57.5%, respectively. The mean age was 59.5 ± 13.5 years. The sample was 65% women, 20% racial/ethnic minority, and 35% resided in rural areas.

Conclusion

These results demonstrate that biomedical informatics resources can be highly effective in recruiting for cancer QOL research. Precisely identifying individuals likely to meet inclusion criteria who previously indicated interest in research participation expedited recruitment. Participants completed the consent and baseline questionnaires with zero follow-up contacts from the research team. This low-touch, repeatable process may be highly effective for multisite clinical trials research seeking to include rural residents.

The value of decentralized clinical trials: Inclusion, accessibility, and innovation

In this Review, we explore the transformative potential of decentralized clinical trials (DCTs) in addressing the limitations of traditional randomized controlled trials (RCTs). We highlight the merits of DCTs fostering greater inclusivity, efficiency, and adaptability. We emphasize the challenges of RCTs, including limited participant diversity and logistical barriers, geographical constraints, and mistrust in research institutions, showing how DCTs are preferred in addressing these challenges by utilizing remote digital technologies and community providers to enable broader, more inclusive participation. Furthermore, we underscore the potential of DCTs for democratizing clinical research. We also stress the importance of addressing unresolved challenges, including data security and privacy, remote patient monitoring, and regulatory variations. Research is needed to devise standardized protocols to streamline DCT processes, explore its long-term impacts on patient outcomes, and overcome challenges through equitable stakeholder engagement.

Recruitment and retention of clinical trial participants: understanding motivations of patients with chronic pain and other populations

This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.