Pragmatic Trial resources


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Site Recruitment Strategies

Once it has been determined which types of sites the trials aims to recruit, a challenge is to inform these sites about the trial and actually have them participate in the trial. More information about this can be found in the paper by Worsley 2017.

Specific challenges

Recruitment may be particularly challenging in pragmatic trials, as the trial is conducted in a routine care setting, where health professionals may be less experienced in, and have fewer resources dedicated to research, as opposed to a more experienced and dedicated research setting (van Staa 2014, Donovan 2014). On the other hand, trials that are embedded in routine care, and require limited additional activities, pose fewer barriers for health care professionals and patients to participate.

Choice of Recruitment strategies

The site recruitment method may affect the type of sites that is selected. It is important to realize how the site selection method could impact on the generalisability, validity and precision and operational feasibility of the trial, although this may be difficult to predict.  Below some examples are shown with possible consequences.

1. Using health professional networks

Using health professional networks may affect the type of sites that is selected. This may decrease generalisability because site recruitment may be limited to only those with health professionals who are sufficiently motivated and engaged to join the network and the use of 'professional patients'. It may also lead to a selection of larger sites, with a higher volume of patients, and on average these sites deliver higher quality. When looking at the operational aspects: health networks cost money. The invested money however might be regained as networks tend to speed up recruitment and increase retention.

2. Using key opinion leaders

Using key opinion leaders may affect the type of sites that is selected. For example the academic or non-academic sites might be more willing to follow the opinion leader, and if the type of site is an effect modifier, it may affect the generalisability of the results. However, the exact consequence is often difficult to predict. Key opinion leaders will usually request a fee, so costs will increase but recruitment might be easier with help of a key opinion leader. Net costs will depend on the effects.

3. Building on existing relations

Building on existing relations probably selects more research oriented sites, and if this is an effect modifier, may affect the generalisability of the results. Existing relations might influence the trial feasibility in a positive way; however, maintenance of relations costs money as well.

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