Recruiting via intermediates

Aim

Practical suggestions how to recruit and maintain relations with professional intermediates like physicians, teachers etc, who help you to recruit participants according to the study protocol. In some cases, the intermediates not only recruit participants but they also take part in the execution of the (intervention) study, for example a new therapy versus usual care or a school campaign. In those cases, if the study is under the remit of Medical Research Involving Human Subjects Act (WMO plichtig), the intermediates are regarded as a ‘deelnemend centrum’ by the METc and the appropriate measures should be taken to enable them to work according to legislation and protocol.

Requirements

• Respect each and every participating intermediate, at every moment of your study.
• Provide an information package documenting the study procedure: what the intermediate needs to know and do with respect to recruiting participants (and, if applicable, after inclusion).
• Make financial agreements with the recruiting intermediates (e.g. incentives, stamps, accreditation, compensation).

How to

A lot of research conducted within APH involves participant recruitment via professional intermediates, such as general practitioners, physical therapists, company and occupational health doctors, youth health physicians, nurses, psychologists, teachers etc. It is always a challenge to include a sufficient number of intermediates and participants. Therefore, it is advised to reserve enough time for approaching these potential intermediates that act as recruiters. And stay enthusiastic, that’s already half of the solution! Independent of all your work and effort, inclusion numbers can still be insufficient. Therefore, it can still be necessary to change the research protocol, e.g. by widening your inclusion criteria, involving more recruiting intermediates, prolongation of the recruiting period, etc. Any change in a research protocol under the remit of Medical Research Involving Human Subjects Act needs to be approved by the Medical Ethical committee (METc).

In case of research not under the remit of this Act (niet-WMO plichtig onderzoek), the METc still strongly advises to inform them about any changes in data collection, informed consent procedure, burden to participants and/or design of the study.

Approaching recruiters

First, start with finding key persons that can support your research in the organization and seek their commitment (e.g., managing board, client representatives, works council (ondernemingsraad)). They can help you find the right persons in the organization for recruiting. Second, potential recruiters are approached for example by sending a letter and brochure explaining the research project and the role of the recruiter (examples: brochure and protocol – see under Download and guideline Attention drawing writing ). In a follow-up telephone call, the written information is further clarified and potentially an appointment is made. The aim of the visit is to explain the study to the recruiter and motivate the recruiter to participate. Generally, recruiters are approached by the primary researcher. Research assistants can be assigned to this task. Here you can find examples of telephone scripts under Download. It is important to tell the potential recruiters that the use of their time will be minimized as much as possible (don’t let recruiters do work that you can do yourself).

Instructing professional intermediates

When professional intermediates are enrolled they need to know the practical procedures of the study and their role herein. This information can be given by telephone, mostly in writing (e-mail) or during a visit. Organizing meetings for all intermediates is a common way to explain the procedures and meet other recruiting intermediates (don’t forget the catering!). If the meeting is a real training course, the intermediates often can receive accreditation points. This can be the case if a training is followed for certain treatment techniques. The researchers must request such accreditation at the relevant professional association.

During a visit or meeting, requisites for the study can be handed over, like procedures, information letters for participants, inclusion forms, questionnaires etc. combined into a binder.

Don’t forget to inform the other people in the organisation of the intermediates, like assistants, nurses, receptionists, human resources department, management etc. They can be crucial for the recruitment! It is often wise to invest time in each recruitment organisation to implement the inclusion procedure in a way which fits the organisation.

Make clear agreements about the informed consent procedure: who does what in obtaining informed consent. The recruiter must approach the potential participants. The researcher is not allowed (by law) to approach potential participants directly. If invitation letters are used to recruit participants, this letter should be sent on behalf of the professional intermediates. Preferably, paper and envelops of their organisation is used (huisstijl), otherwise use blank paper/envelops, but make sure it is clear to the potential participant from whom the letter is. Do not use VU/VUmc paper/envelopes for letters that will be send by intermediates to potential participants. The researcher should make financial arrangements for the costs of sending these letters.  Alternatively, with explicit permission of the potential participant the recruiting intermediate is allowed to give their contact details to the research team. It is strongly recommended that such permission is in writing, or at least documented, e.g. in the medical record of the potential participant. When the intermediates or potential participant inform you of their potential interest, you can send the potential participants the study information as part of the informed consent procedure. Note for protocols under the remit of the Medical Research Involving Human Subject Act (WMO studies) the informed consent procedure can be different; the METc will tell you what is allowed.

Recruitment enhancing tips

Here are several tips to enhance recruitment via professional intermediates:

• Keep the intermediates informed about the progress of the study! They like to know what the results are of their effort. This can be done on individual or broader group level. Provide the individual intermediates feedback about the inclusion or exclusion of the participants delivered by the intermediate, possibly accompanied with measurement results. Results of individual participants can only be shared with the intermediate with documented permission of the participant. At a broader level, intermediates can also be informed by a newsletter or during a meeting including catering. For newsletters it is advised to make these specific for the target group, in this case the professional recruiters, which should be as concise as possible and contain information relevant for them.
• Investigate possible causes for disappointing recruitment. Gently ask the intermediates about the possible causes, through a telephone call, visit or meeting. Search together with the intermediates for solutions. Let the intermediates know that they always can give you a call. Don’t forget to switch on an answering machine during absence, and be aware that these messages may contain sensitive (privacy) information.
• Make the study recognizable! Use logos on every suitable object, and on your correspondence (letters, e-mail, website). You can use custom made stamps with your logo to mark envelopes
• During the recruitment period you can give the intermediates small presents like vouchers for film, theatre or gifts, sweets (Easter eggs, chocolate letters, bon-bon) or bottle of wine. If you are ordering large amounts, try to get discounts from the suppliers. Business presents with your logo reminds the intermediates of your study. Examples: mugs, pencils, memo pads , t-shirts.
• Send cards for special occasions Christmas, Easter, summer holiday etc.