Table 3 Summary of trial recruitment intervention co-design workshop discussion with maternity healthcare professionals and maternity service users: workshop 1
Recruiter’s list and compare advantages and disadvantages of inviting all eligible women to participate in a trial 9.2 Pros and cons (linked subthemes—the ‘right’ participants and acceptability of the intervention) | • Good to do at start of study, discuss how to approach and reassess once study is underway • Depends on resources and capacity to screen women to do this • Inviting all women promotes research—helpful for future studies • This is not something consciously done at the moment • Important to include underrepresented, non-English speaking, ethnic, and cultural minorities • Wouldn’t use this method—prefer team-based approach to make trial more appealing, educate public about what a trial involves • Tool is more helpful for trials difficult to recruit to or struggling—could modify approach by recognising problem |
Set an agreed daily/weekly goal to invite all eligible women 1.1 Goal setting (behaviour) (linked subthemes—putting women’s clinical care and wellbeing first and commitment to the research and recruitment targets) | • Setting targets helps—nice to be first to recruit and gain sense of achievement • Depends on trial, some trials you really can’t set goals for (lack of staff, not enough patients, etc.) • Tool could be helpful in identifying where problems are—should be reward rather than punishment system • Goals depend on staff availability and staff to support women throughout the trial ‘• Goals’ focuses on quantity not quality—talking to everyone spreads yourself too ‘thin on the ground’ • ‘Goals’ not good, means just another pressure—wouldn’t benefit the trial • Better to concentrate on areas to target (ward, clinics etc.) for recruitment rather than numbers |
Set an agreed weekly goal to have increased the number of women invited to the trial 1.3 Goal setting (outcome) (linked subthemes—recruitment targets) | • This one is about incentivising people to approach more women than they are doing currently • If you are recruiting well, you do not need this • Inviting everyone could be a tick box exercise (invitees may not sign up for study) • Most multicentre sites do not know how many women have been invited—screening logs are not routinely looked at • Tool might be useful on a local level to know if you are targeting the right areas • Tool is useful if talking to lots of women means lots of recruits • It is the quality of the chat not the numbers invited—its deeper than just numbers • Goals motivate people; it gets people working together on something • It would be more beneficial to look back retrospectively to learn rather than set goals |
Experienced recruiters give talk (or video clip) about resolving situations that commonly occur prior to inviting a woman to a trial 4.2 Information about antecedents (linked subthemes—planning and preparation and being visible and benefit of experience) | • Include people from different backgrounds, recruiters from ethnic minorities have different experiences and are asked different questions • This could cover a range of difficulties faced—talk through and present ways of resolving those • Also helpful in deflecting concerns and uncertainties in the clinical team—addressing these head on is sensible • May not video but a meeting or something at local level—because issues differ from site to site • Could be PI, R&D lead, research midwife/nurse delivering • Could be virtual conservation so people could ask questions, and provide recording to watch back • Zoom meetings for recruiters are held for some trials but are not always accessible as timing does not always suit staff • WhatsApp voice notes are helpful for recruiters to communicate their methods to other recruiters • Good idea to have one video at set up and one subsequently as may need to adapt approach as trial goes on |
Recruiters keep diary of recruitment or potential recruitment encounters (reflecting on diary and shared learning with peers) 2.3 Self-monitoring of behaviour (linked subthemes—being visible and planning and preparation) | • Writing in diary is useful, means you will remember • Write significant encounters, difficulties, or learnings—do not want to record every single thing • Fill them out when you have time—can be brief as they need to be • Diary is reflective and more useful than a screening log • Could be recorded centrally or as a personal record—Sharing diary is not problematic (all agreed) • Positive consequence—the record shows difficulties or missed opportunities which could justify argument for more resources • Tool could be helpful to show R&D why recruitment is problematic • Not sure reflection is helpful—if you are recruiting well why are you reflecting on it? • Diary provides retrospective perspective, helpful in identifying where women could potentially be missed |
Regular review (with trial team) of the change in behaviour being used by recruiters 1.5 Review behaviour goals (linked subthemes—recruitment targets) | • Might be helpful if you are not recruiting well—see where you could improve • Not regular review—better to positively motivate people with degree of healthy competition • Trial team already send league tables—giving shout out to top recruiter • On a local level you can incentivise with chocolates, etc.—small stuff means something • Already being done—it really helped concentrating on where is focus efforts • Review of behaviour change ensures you are doing your best and change if necessary |
Trials teams carry out monthly review to reveal if all eligible women had been invited to the trial 1.7 Review outcome goals (linked subthemes—recruitment targets) | • This is not achievable as there is no record of ‘all women’—not possible to know about all eligible women • You already know if you have approached all eligible women, and if not, you know why • This is not useful because capacity of the team is often the problem • Review helps people write down the issues and address them • A positive consequence might be reallocation of staff following review |