Common Problems Recruiting to Trials or Specific Challenges? a Qualitative Evaluation of Factors Affecting Recruitment into a Randomised Controlled Trial of Foster Care Training

Background

Randomised control trials (RCTs) are less commonly used to evaluate social care interventions in the UK than other study designs but where feasible, offer distinct advantages for outcome evaluation. Confidence in Care (CiC) is an RCT with embedded process evaluation trialling Fostering Changes (FC), a 12-week training programme for foster and kinship carers to increase skills and coping strategies. A common challenge in all trials, including those in social care is that of participant recruitment. Poor recruitment can reduce power, lead to sample bias and add to research costs. Factors affecting recruitment may be multi-faceted and are likely also to vary by study setting. We designed an engagement strategy to maximize foster carer recruitment from local authority departments of children’s social care and independent foster providers (service providers). Although target sample size was surpassed, this was only after further tailoring of our approach. To better understand setting-specific issues in trial recruitment we undertook a process evaluation incorporating key study stakeholder groups

Methods

We conducted two focus groups with (n=7) field-based staff responsible for recruiting study participants to explore their experiences of recruiting to the trial. A focus group was also conducted with (n=8) foster carers who attended the FC programme. Five interviews were conducted with facilitators responsible for delivering FC. Two members of the research team facilitated group discussions and a postgraduate social work student conducted interviews. Transcribed audio-recorded data were inductively coded, double-coded by a second researcher, and thematically analysed. Participants provided informed consent.

Results

Six themes were identified. The first addressed aspects of the intervention that may affect recruitment (e.g. practical challenges of committing to a 12-week training programme). A second theme focused on communication between service providers and carers, in particular its accuracy. A third theme was concerned with the ability of recruiting staff to contact foster carers when recruiting, a particular challenge when attempting group-based recruitment. A fourth theme addressed trial-related aspects such as the relationship between office-based trial team and field-based recruiters. A fifth theme explored the lack of differentiation by foster carers between the roles of the various professional groups (i.e. facilitators delivering FC, trial staff, and usual service providers). The sixth theme addressed observations by stakeholders of differences between recruitment into social care and health studies (e.g. governance requirements, different levels of professional gatekeeping).

Discussion

Field-based research staff, foster carers, and FC facilitators provided insights into their recent experiences of recruitment into a social care trial. Recruitment challenges similar to those in other studies were found. Some of these (e.g. direct and indirect gatekeeping by professional staff) may have been rooted in randomisation anxiety, although concern about randomisation was less evident amongst carers themselves. Some challenges may have stemmed from a relative unfamiliarity from all parties with social care research. However, there was an overall positive feeling, particularly from the field-based staff, about the experience of working in this social care setting. The original recruitment strategy and adaptations based on study experiences form the basis of further recommendations for research practice.