Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network

Article

Borschmann, R., Patterson, S., Poovendran, D., Wilson, D. and Weaver, T. 2014. Influences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network. BMC Medical Research Methodology. 14 (1), p. 23. https://doi.org/10.1186/1471-2288-14-23
TypeArticle
TitleInfluences on recruitment to randomised controlled trials in mental health settings in England: a national cross-sectional survey of researchers working for the Mental Health Research Network
AuthorsBorschmann, R., Patterson, S., Poovendran, D., Wilson, D. and Weaver, T.
Abstract

Background: Recruitment to trials is complex and often protracted; selection bias may compromise generalisability. In the mental health field (as elsewhere), diverse factors have been described as hindering researcher access to potential participants and various strategies have been proposed to overcome barriers. However, the extent to which various influences identified in the literature are operational across mental health settings in England has not been systematically examined.
Methods: A cross-sectional, online survey of clinical studies officers employed by the Mental Health Research Network in England to recruit to trials from National Health Service mental health services. The bespoke questionnaire invited participants to report exposure to specified influences on recruitment, the perceived impact of these on access to potential participants, and to describe additional positive or negative influences on recruitment. Analysis employed descriptive statistics, the framework approach and triangulation of data.
Results: Questionnaires were returned by 98 (58%) of 170 clinical studies officers who reported diverse experience. Data demonstrated a disjunction between policy and practice. While the particulars of trial design and various marketing and dommunication strategies could influence recruitment, consensus was that the culture of NHS mental health services is not donducive to research. Since financial rewards for recruitment paid to Trusts and feedback about studies seldom reaching frontline services, clinicians were described as distanced from research. Facing continual service change and demanding clinical workloads, clinicians generally did not prioritise recruitment activities. Incentives to trial participants had variable impact on access but recruitment could be enhanced by engagement of senior investigators and integrating referral with routine practice. Comprehensive, robust feasibility studies and reciprocity
between researchers and clinicians were considered crucial to successful recruitment.
Conclusions: In the mental health context, researcher access to potential trial participants is multiply influenced. Gatekeeping clinicians are faced with competing priorities and resources constrain research activity. It seems that environmental adjustment predicated on equitable resource allocation is needed if clinicians in NHS mental health services are to fully support the conduct of randomised controlled trials. Whilst cultural transformation, requiring changes in assumptions and values, is complex, our findings suggest that attention to practical matters can support this and highlight issues requiring careful consideration.

KeywordsRandomised controlled trials; Recruitment ; Mental health; Survey; Clinical studies officers; CSOs ; Mental Health Research Network; National Health Service; NHS ; England
JournalBMC Medical Research Methodology
ISSN1471-2288
Publication dates
Print17 Feb 2014
Publication process dates
Deposited03 May 2016
Accepted07 Feb 2014
Output statusPublished
Publisher's version
License
Digital Object Identifier (DOI)https://doi.org/10.1186/1471-2288-14-23
Web of Science identifierWOS:000331833300001
LanguageEnglish
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Read, J., Kinali, M., Muntoni, F., Weaver, T. and Garralda, E. 2011. Siblings of young people with Duchenne muscular dystrophy -- a qualitative study of impact and coping. European Journal of Paediatric Neurology. 15 (1), pp. 21-28. https://doi.org/10.1016/j.ejpn.2010.07.006
Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study
Singh, S.P., Paul, M., Ford, T., Kramer, T., Weaver, T., McLaren, S., Hovish, K., Islam, Z., Belling, R. and White, S. 2010. Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. The British Journal of Psychiatry. 197 (4), pp. 305-312. https://doi.org/10.1192/bjp.bp.109.075135
Drug service user groups: only a partial solution to the problem of developing user involvement
Patterson, S., Weaver, T. and Crawford, M. 2010. Drug service user groups: only a partial solution to the problem of developing user involvement. Drugs: Education, Prevention, and Policy. 17 (1), pp. 84-97. https://doi.org/10.3109/09687630802225495
The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in community mental health teams
Newton-Howes, G., Tyrer, P., Anagnostakis, K., Cooper, S., Bowden-Jones, O. and Weaver, T. 2010. The prevalence of personality disorder, its comorbidity with mental state disorders, and its clinical significance in community mental health teams. Social Psychiatry and Psychiatric Epidemiology. 45 (4), pp. 453-460. https://doi.org/10.1007/s00127-009-0084-7
A qualitative study of illicit and non-prescribed drug use amongst people with psychotic disorders
Charles, V. and Weaver, T. 2010. A qualitative study of illicit and non-prescribed drug use amongst people with psychotic disorders. Journal of Mental Health. 19 (1), pp. 99-106. https://doi.org/10.3109/09638230802523039
Child involvement in the paediatric consultation: a qualitative study of children and carers' views
Taylor, S., Haase-Casanovas, S., Weaver, T., Kidd, J. and Garralda, E.M. 2010. Child involvement in the paediatric consultation: a qualitative study of children and carers' views. Child: Care, Health and Development. 36 (5), pp. 678-685. https://doi.org/10.1111/j.1365-2214.2010.01076.x
Delusions and qualitative confusions: a dialogic collaborative exploration
Patterson, S., Hart, J. and Weaver, T. 2010. Delusions and qualitative confusions: a dialogic collaborative exploration. Qualitative Health Research. 20 (7), pp. 1008-1018. https://doi.org/10.1177/1049732310363805
Assessment of adverse effects in clinical studies of antipsychotic medication: survey of methods used
Pope, A., Adams, C., Paton, C., Weaver, T. and Barnes, T.R.E. 2010. Assessment of adverse effects in clinical studies of antipsychotic medication: survey of methods used. The British Journal of Psychiatry. 197 (1), pp. 67-72. https://doi.org/10.1192/bjp.bp.109.070961
User involvement in efforts to improve the quality of drug misuse services in England: a national survey
Patterson, S., Weaver, T., Agath, K., Rutter, D., Albert, E. and Crawford, M. 2009. User involvement in efforts to improve the quality of drug misuse services in England: a national survey. Drugs: Education, Prevention, and Policy. 16 (4), pp. 364-377. https://doi.org/10.1080/09687630802061544
Dedicated personality disorder services: a qualitative analysis of service structure and treatment process
Price, K., Gillespie, S., Rutter, D., Dhillon, K., Gibson, S., Faulkner, A., Weaver, T. and Crawford, M.J. 2009. Dedicated personality disorder services: a qualitative analysis of service structure and treatment process. Journal of Mental Health. 18 (6), pp. 467-475. https://doi.org/10.3109/09638230902968191
'They can't solve the problem without us': a qualitative study of stakeholder perspectives on user involvement in drug treatment services in England
Patterson, S., Weaver, T., Agath, K., Albert, E., Rhodes, T., Rutter, D. and Crawford, M. 2009. 'They can't solve the problem without us': a qualitative study of stakeholder perspectives on user involvement in drug treatment services in England. Health and Social Care in the Community. 17 (1), pp. 54-62. https://doi.org/10.1111/j.1365-2524.2008.00797.x
Transitions of care from child and adolescent mental health services to adult mental health services (TRACK study): a study of protocols in Greater London
Singh, S., Paul, M., Ford, T., Kramer, T. and Weaver, T. 2008. Transitions of care from child and adolescent mental health services to adult mental health services (TRACK study): a study of protocols in Greater London. BMC Health Services Research. 8 (1), pp. 1-7. https://doi.org/10.1186/1472-6963-8-135
Attitudes of staff towards patients with personality disorder in community mental health teams
Newton-Howes, G., Weaver, T. and Tyrer, P. 2008. Attitudes of staff towards patients with personality disorder in community mental health teams. Australian & New Zealand Journal of Psychiatry. 42 (7), pp. 572-577. https://doi.org/10.1080/00048670802119739
Social functioning of patients with personality disorder in secondary care
Newton-Howes, G., Tyrer, P. and Weaver, T. 2008. Social functioning of patients with personality disorder in secondary care. Psychiatric Services. 59 (9), pp. 1033-1037. https://doi.org/10.1176/ps.2008.59.9.1033
Dedicated community-based services for adults with personality disorder: Delphi study
Crawford, M.J., Price, K., Rutter, D., Moran, P., Tyrer, P., Bateman, A., Fonagy, P. and Weaver, T. 2008. Dedicated community-based services for adults with personality disorder: Delphi study. The British Journal of Psychiatry. 193 (4), pp. 342-343. https://doi.org/10.1192/bjp.bp.107.043042
Qualitative investigation of the mental health of migrants from former Yugoslavia: implications for epidemiological research
Djuretic, T., Crawford, M. and Weaver, T. 2007. Qualitative investigation of the mental health of migrants from former Yugoslavia: implications for epidemiological research. Journal of Mental Health. 16 (6), pp. 743-755. https://doi.org/10.1080/09638230701496394
Prevalence of personality disorder in alcohol and drug services and associated comorbidity
Bowden-Jones, O., Iqbal, M., Tyrer, P., Seivewright, N., Cooper, S., Judd, A., Weaver, T. and the COSMIC study team 2004. Prevalence of personality disorder in alcohol and drug services and associated comorbidity. Addiction. 99 (10), pp. 1306-1314. https://doi.org/10.1111/j.1360-0443.2004.00813.x
User involvement in the planning and delivery of mental health services: a cross-sectional survey of service users and providers
Crawford, M.J., Aldridge, T., Bhui, K., Rutter, D., Manley, C., Weaver, T., Tyrer, P. and Fulop, N. 2003. User involvement in the planning and delivery of mental health services: a cross-sectional survey of service users and providers. Acta Psychiatrica Scandinavica. 107 (6), pp. 410-414. https://doi.org/10.1034/j.1600-0447.2003.00049.x
Assessing the value of assertive outreach: Qualitative study of process and outcome generation in the UK700 trial
Weaver, T., Tyrer, P., Ritchie, J. and Renton, A. 2003. Assessing the value of assertive outreach: Qualitative study of process and outcome generation in the UK700 trial. The British Journal of Psychiatry. 183 (5), pp. 437-435. https://doi.org/10.1192/bjp.183.5.437
Results of a screening survey for co-morbid substance misuse amongst patients in treatment for psychotic disorders: prevalence and service needs in an inner London borough
Weaver, T., Rutter, D., Madden, P., Ward, J., Stimson, G. and Renton, A. 2001. Results of a screening survey for co-morbid substance misuse amongst patients in treatment for psychotic disorders: prevalence and service needs in an inner London borough. Social Psychiatry and Psychiatric Epidemiology. 36 (8), pp. 399-406. https://doi.org/10.1007/s001270170030
The prevalence and management of co-morbid substance misuse and mental illness: results of a screening survey in substance misuse and mental health treatment populations
Weaver, T., Hickman, M., Rutter, D., Ward, J., Stimson, G. and Renton, A. 2001. The prevalence and management of co-morbid substance misuse and mental illness: results of a screening survey in substance misuse and mental health treatment populations. Drug and Alcohol Review. 20 (4), pp. 407-416. https://doi.org/10.1080/09595230120092724
Residents' perceptions of water quality improvements following remediation work in the Pymme's Brook catchment, north London, UK
Faulkner, H., Green, A., Pellaumail, K. and Weaver, T. 2001. Residents' perceptions of water quality improvements following remediation work in the Pymme's Brook catchment, north London, UK. Journal of Environmental Management. 62 (3), pp. 239-254. https://doi.org/10.1006/jema.2001.0435
The Bentham unit: a pilot remand and assessment service for male mentally disordered remand prisoners. II: Report of an independent evaluation
Weaver, T., Taylor, F., Cunningham, B. and Maden, A. 1997. The Bentham unit: a pilot remand and assessment service for male mentally disordered remand prisoners. II: Report of an independent evaluation. The British Journal of Psychiatry. 170 (5), pp. 462-466. https://doi.org/10.1192/bjp.170.5.462