Recruitment and Retention of Research Participants: Experiences of a Longitudinal Qualitative study

1. Recruitment and Retention
of Research Participants:
Experiences from a Longitudinal
Qualitative Study
19th Qualitative Health Research Conference
at Halifax, Canada, 27-29 October 2013
Dr. E. van Wijk
Western Cape College of Nursing, Cape Town, South Africa
Evalina.vanWijk@westerncape.gov.za

2. Outline
 Introduction
 Purpose
& Research Question
 Research Design
 Study Location/Access
 Pilot Study Challenges
& Lessons
 Main Study Period
 Tracking Strategies
 Recruitment Process
 Difficulties – Recruitment
& Data Collection
 Pilot Study Period
 Ethics
 Data Collection
Methods
 Data Analysis/Trustworthiness
 Implications &

3. Introduction
•
Recruitment, tracking and retention of male intimate
partners of female rape victims - an under-researched area
globally and esp. South Africa, where rape incidence is high
•
Apparently the first qualitative study to explore phenomenon
from nursing viewpoint over extended period

4. Definitions
• Recruitment:
Getting attention of / attracting potential research participants
• Retention:
Research participants remaining in study for duration,
to provide valuable data and attain study objectives.
– Also referred to as “attrition”
(participants leave study prematurely; “lost to follow-up”)
• Can be influenced by study itself or staff
• Participants and even Researcher can make / break retention.

5. Purpose & Research Question
Purpose:
•To describe processes followed to recruit, track and retain
participants in this longitudinal phenomenological study
•To highlight methodological difficulties encountered
•Lessons learned from the study.
Research Question:
“What constitutes an intimate partner’s experience of living
with a rape victim within the first six months post-rape?”

6. Research Design
•
Longitudinal hermeneutic phenomenological study;
Male intimate partners (MIPs) interviewed over six months
•
Why six-month study period ?
•
Hermeneutic focus on interpretation of language and meanings
of individuals’ experiences
•
Pilot Study Aim:
To determine if planned research methods (access, recruitment,
interviewing) were appropriate / ethically sound

7. Research Design - Population & Sampling
•
Male intimate partners of female rape victims who received
treatment at selected rape centre
•
Participants sampled / recruited if:
-
In intimate relationship with female rape victim before
and immediately after rape event
(as revealed by rape victim to the nursing staff)
-
Older than 18 years
-
Able to communicate - isiXhosa, English or Afrikaans
-
Voluntarily contacted researcher within 14 days of learning
of study - willingness to participate for six month period

8. Study Location
• Recruitment centre for comprehensive treatment / support of
rape- & sexual assault victims
• Low socioeconomic area of Cape Town

9. Access - Rape Centre
•
Clinical managers informed by letter of study’s
significance & purpose
•
Ethical clearance obtained from UCT
After consent given:
•
Meeting Rape Centre medical / nursing staff
to brief them on:
–
–
–
–
–
Study’s purpose
Recruitment procedure
Selection criteria - participants
Projected duration
Researcher’s role.

10. Access - to MIPs via Rape Victim
• Medical / nursing staff identified female rape victims
in intimate relationship with partner of any gender,
as disclosed by victim
• Either:
directly after rape event, or
at 72-hour follow-up visit
• Staff requested to gently inform victims of nature of study
• Then asked, without coercion, if they want to meet
researcher

11. Access - to MIPs via Rape Victim
If the response affirmative:
•Victim seen in private room, study’s purpose explained:
- verbally
- via information document
•Victim could afterwards discuss study with intimate partner,
who must then voluntarily contact researcher telephonically
within 14 days of learning of study, and
•Express willingness to attend four interviews over six months

12. Recruitment Process
After contacting researcher / expressing interest in study:
•Individual appointments set up to enroll potential participants
At this meeting, the following explained / obtained:
•Study’s aims
•Researcher’s role / responsibilities concerning ethical
considerations in the process
•Specific focus:
Anonymity, Confidentiality, Informed Consent
•How information gained would be processed

13. Recruitment Process
At this meeting the following explained / obtained:
•Permission sought - use digital audio recorder
•Participants reminded of their:
- right to not answer uncomfortable questions, and
- option to withdraw from study without giving reasons
•Voluntary informed consent

14. Pilot Study Period
February 2008 - July 2008
•
12 potential participants made contact at first
•
8 participants started with the interviews;
4 participants dropped out
•
Due to sample attrition, sampling process extended
•
2 out of 4 remaining participants completed Pilot Study over
six months

15. Data Collection Methods – Pilot / Main Study
• Four separate face-to-face, semi-structured interviews:
– 14 days
– A month
– Three months
– Six months after rape
• All interviews: similar structure (audio recorded, one-on-one)
• Interpreter for all three languages of Western Cape Province
- halfway through Pilot Study
• Reflective journal / field notes
• Data collected evenings / weekends

16. Pilot Study - Challenges & Lessons
• Participants would rather attend researcher‘s office / home,
or safe place far from own homes
• Appointment cards issued for building access
• Both prefer not to divulge personal contact details
• Language barrier
• Disappointment that interpreter not present
• Methodology adjusted for Main Study:
1. Interpreter included
2. Modified interview questions

17. Main Study Period
August 2008 - August 2009
Of the 16 participants in Main Study:
• 7 did not attend their second and subsequent
interviews
• 9 completed all four planned interviews

18. Tracking Strategies to Retain Participants
1. Locating for follow-up interviews:
• Regular telephonic contact
• Numerous “please call me” text messages
- contacted immediately
• Participants asked to:
Provide names / addresses / phone numbers of two
people who know their whereabouts during study and
whom researcher could contact if needed
Inform researcher of change in contact details

19. Tracking Strategies to Retain Participants
1. Locating for follow-up interviews:
• Request repeated after each follow-up interview
• After each follow-up, participants asked to confirm
own as well as their family / friends’ contact details to update
their personal files

20. Tracking Strategies to Retain Participants
1. Locating for follow-up interviews:
• Mobile phone text messages to participants:
Reminder of next interview date
• Lost participants:
Repeated attempts to re-establish contact
telephonically
• Obtaining participants’ home addresses

21. Tracking Strategies to Retain Participants
1. Locating for follow-up interviews:
After each interview, participant received card with:
•
Researcher’s contact details
•
Date of next interview
•
Previously agreed-upon payment for time and travel costs

22. Tracking Strategies to Retain Participants
2. Using caller identity:
• A service available from mobile phone provider:
Displays name / phone number of potential recruit,
(supplied by rape victim at recruitment site)
on researcher’s cellphone
• Allowed speedy identification of / establish contact
with potential recruits, who could contact researcher
from any location at any time.

23. Tracking Strategies to Retain Participants
3. Sensitivity to participant’s emotional life
•
Due to nature of study, participants regarded as
category of vulnerable people
•
Identified stressors resolved timeously
•
Referral to crisis support services / counsellor
•
Regular contact maintained with participants

24. Tracking Strategies to Retain Participants
4. Ensuring participants’ safety
Most rapes occurred in informal, densely-populated,
high-crime-rate, peri-urban shanty town settlements
• To protect participants’ anonymity / confidentiality and
ensure their personal safety - interviews not conducted in /
near own living space
• Family / friends used to trace them

25. Tracking Strategies to Retain Participants
5. Strategies to motivate participants
• Potential recruits given study information document:
- Non-technical language
- Translated into the three languages
- Study made culturally appropriate - interpreters
• Regular follow-up calls
• Refreshments provided:
- Long interviews, and
- Some participants came directly from work
• Contact details updated after each follow-up interview

26. Tracking Strategies to Retain Participants
5. Strategies to motivate participants
• Reminders for interviews:
- one week before, and
- one day before interview
• Ask person answering the phone to identify him / herself

27. Tracking Strategies to Retain Participants
6. Monetary incentives
•
One opinion: “Money most effective incentive”
(Lyons, Carter, Carter, Rush, Stewart, & Archbold, 2004;
Cooley, Sarna, Brown, Williams, Chernecky, Padilla, & Danao,
2003; DiMattio, 2001)
•
Others say: “Coercion and a violation of human rights”
(Rudy, Estok, Kerr, & Menzel, 1994; Moore, 1997)
• My approach:
- Participants received $7 USD / interview
- Some potential participants said “It’s too little”
- 9 participants: “Money not reason for participation”

28. Tracking Strategies to Retain Participants
7. Planning for termination of researcher-participant
relationship
A challenge, since a reciprocal bond of trust had developed
• Participants prepared from first interview for the
termination of the research
• At each subsequent interview, reminded of number of
remaining interviews
• On final visit, ample time for reflection and to thank
participant for taking part

29. Difficulties - Recruitment & Data Collection
• Interview clashes with participants working hours
• Language differences
• Selection criteria issues
(Many of the rape victims separated from partners
/ not in stable, intimate relationships)
• Unavailable subscriber on mobile phone
• Numerous automatic “Please call me” mobile phone
text messages - high telephone bills

30. Difficulties - Recruitment & Data Collection
• Suspicions of partners
• Researcher – participant relationship
• Gender & cultural differences between researcher
& participants
• Tracking participants longitudinally a complex task –
to re-open recruitment
• High attrition rate of participants - Pilot / Main Study

31. Difficulties - Recruitment & Data Collection
•
Given that participants were traumatized, several features
needed attention:
– Costly - adequate funding needed
– Time constraints

32. Ethical Considerations
•
Ethical approval obtained from UCT Faculty of Health Sciences
Human Research Ethics Committee and the RCC management
•
Study conducted according to Declaration of Helsinki principles
(World Medical Association October 2008)
- Anonymity / Confidentiality
- Preventing harm to participants
- Autonomy / Beneficence / Justice of medical research
•
Referral to counsellors if needed
•
Participants interviewed at mutually agreed-upon time
at safe venue - they preferred not in natural environment.

33. Data Analysis
• Data transcribed / analysed within 24 hours after interview
because preliminary findings informed questions for
subsequent sessions
• Methods of Colaizzi (1978) and within-case and across-case
approach (Ayres, Kavanaugh and Knafl, 2003)
•
Interpretive theory of Paul Ricœur (1976)
• Data interpretation involved reflecting on initial reading
•
With interpretive lens to ensure comprehensive
understanding of findings

34. Trustworthiness
•
Prolonged engagement
•
Member checking
•
Reflective journal:
Reflexivity
Disclosure of personal feelings
Background
Perceptions
Pre-conceptions
Biases
Assumptions
Role in the study

35. Implications
• Future qualitative researchers would do well to heed
the challenges and lessons learned from this longitudinal
research study
• Failure to attend to these issues will lead to personal
frustration and wasted time / money.

36. Recommendations
• Logical research design to recruit / locate / retain
participants
• Proper tracking strategies to maintain participants during
data collection
• Ongoing evaluation of tracking strategies
(avoid delayed / inefficient recruitment and loss of
participants)
• Continuously inform participants of research goals
and what is expected of them
• Ongoing collaboration with staff at the recruitment facility
• Respect and flexibility for participants’ time and expressions

37. Recommendations
• Ethical recruitment strategies & principles throughout
• Providing appropriate incentives - fair reimbursements
• Recruitment / tracking / retention = critical components
when vulnerable population involved in longitudinal
sexual assault research
• Ongoing attempts to improve the retention of
participants
• Address safety issues
• Referral to mental health care facilities and other NGO
resources, e.g. Rape Crisis Centre & Life Line.

38. Acknowledgements
•
19th Qualitative Health Research (QHR) Conference Organisers;
•
African Population and Health Research Centre (APHRC)
in partnership with International Development Research Centre
(IDRC);
•
Cape Peninsula University of Technology, Cape Town,
Republic of South-Africa;
•
Department of Health, Western Cape Province,
Republic of South Africa;
•
Margaret McNamara Research Foundation;
•
Prof. S. Duma & Prof. P. Myers
(supervisors from UCT, Republic of South Africa).

39. Thank you