Widening participation – recruitment methods in mental health randomised controlled trials: a qualitative study

Iflaifel, Mais; Hall, Charlotte L.; Green, Heidi R.; Willis, Andrew; Rennick-Egglestone, Stefan; Juszczak, Edmund; Townsend, Mark; Martin, Jennifer; Sprange, Kirsty

Abstract

Background: Barriers to mental health research participation are well documented including distrust of services and research; and stigma surrounding mental health. They can contribute to a lack of diversity amongst participants in mental health research, which threatens the generalisability of knowledge. Given the recent widespread use of the internet in medical research, this study aimed to explore the perspectives of key partners on the use of online (e.g. social media) and offline (e.g. in-person) recruitment as an approach to improving diversity in mental health randomised controlled trials (RCTs).
Methods: Face-to-face and online interviews/focus groups with researchers working in mental health and Patient and Public Involvement partners in the United Kingdom. Recordings were transcribed and analysed using a combination of inductive and deductive thematic analysis.
Results: Three focus groups and three interviews were conducted with a total N=23 participants. Four overarching themes were identified: (1) recruitment reach; (2) Demographic factors that affect selection of recruitment method; (3) safety of technology, and; (4) practical challenges. Five main factors were identified that affect the choice of recruitment method: age, complexity of mental health problem and stigma, cultural and ethnicity differences and digital divide. The use of online methods was considered more accessible to people who may feel stigmatised by their mental health condition and with a benefit of reaching a wider population. However, a common view amongst participants was that online methods require closer data monitoring for quality of responders, are not fully secure and less trustworthy compared to offline methods that enable participants to build relationships with health providers. Funding, staff time and experience, organisational support, and technical issues such as spam or phishing emails were highlighted as practical challenges facing online recruitment. All participants agreed that using a hybrid approach tailored to the population under study is paramount.
Conclusions: This study highlighted the importance of offering a flexible and multifaceted recruitment approach by integrating online with offline methods to support inclusivity and widening participation in mental health research. The findings will be used to develop considerations for researchers designing RCTs to improve recruitment in mental health research.

• Journal Article Type: Article
• Acceptance Date: Sep 8, 2023
• Online Publication Date: Sep 21, 2023
• Publication Date: 2023
• Deposit Date: Sep 11, 2023
• Publicly Available Date: Sep 28, 2023
• Journal: BMC Medical Research Methodology
• Electronic ISSN: 1471-2288
• Publisher: Springer Science and Business Media LLC
• Peer Reviewed: Peer Reviewed
• Volume: 23
• Issue: 1
• Article Number: 211
• DOI: https://doi.org/10.1186/s12874-023-02032-1
• Keywords: Mental health, Recruitment, Randomised controlled trials, Thematic analysis, Stigma, Digital divide, Diversity, Inclusivity
• Public URL: https://nottingham-repository.worktribe.com/output/25181563
• Publisher URL: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/s12874-023-02032-1
• Additional Information: Received: 3 May 2023; Accepted: 8 September 2023; First Online: 21 September 2023; : ; : The authors declare no competing interests.; : The RE-MIND study received University of Nottingham Ethical approval (FMHS 13–0422) on 13th June 2022. Informed consents were accepted as a return of email (to the invitation email) stating the participant had read and understood the consent form and agreed to participate. This study was carried out in compliance with Ethical Principles for Medical Research Involving Human Subjects outlined in the Helsinki Declaration [CitationRef removed]. The researcher(s) explained to participants that entry into the study was entirely voluntary and that they could withdraw at any time. In the event of withdrawal, it was clear to the participants that their data collected could not be erased and would be used in the final analyses where appropriate.; : N/A.