Abstract
Background
The Turnaway Study is designed to prospectively study the outcomes of women who sought—but
did not all obtain—abortions. This design permits more accurate inferences about the
health consequences of abortion for women, but requires the recruitment of a large
number of women from remote health care facilities to a study a sensitive topic. This
paper explores the Turnaway Study's recruitment process.
Methods
From 2008 to 2010, the staff at 30 abortion-providing facilities recruited eligible
female patients. Eight interventions were evaluated using multilevel logistic regression
for their impact on eligible patients being approached, approached patients agreeing
to go through informed consent by phone, and enrolled patients completing the baseline
interview.
Findings
After site visits, patients had roughly twice the odds of being approached by facility
staff and twice the odds of then agreeing to go through informed consent. When all
recruitment steps were considered together, the net effect of site visits was to increase
the odds that eligible patients participated by nearly a factor of six. After the
introduction of a patient gift card incentive, patients had over three times the odds
of agreeing to go through informed consent. With each passing month, however, staff
demonstrated a 9% reduced odds of approaching eligible patients about the study.
Conclusion
Prioritizing scientific rigor over the convenience of using existing datasets, the
Turnaway Study confronted recruitment challenges common to medical practice-based
studies and unique to sensitive services. Visiting sites and communicating frequently
with facility staff, as well as offering incentives to patients to hear more about
the study before informed consent, may help to increase participation in prospective
health studies and facilitate evaluation of sensitive women's health services.
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References
Alderman, J., Borkar, G. G., Garrett, A., Hogan, L., Kim, J., Le, W., et al. (2005). The most conservative and liberal cities in the United States: The Bay Area Center for Voting Research. Berkely, CA: Bay Area Center for Voting Research.
- Recruitment of newly diagnosed ovarian cancer patients proved challenging in a multicentre biobanking study.Journal of Clinical Epidemiology. 2011; 64: 525-530
- Abortion and long-term mental health outcomes: a systematic review of the evidence.Contraception. 2008; 78: 436-450
- Improving the recruitment activity of clinicians in randomised controlled trials: A systematic review.BMJ Open. 2012; 2: e000496
- An analysis of factors that predict patient consent to take part in a randomized controlled trial.Family Practice. 2007; 24: 388-394
- Recruiting older people to a randomised controlled dietary intervention trial–How hard can it be?.BMC Medical Research Methodology. 2010; 10: 17
- How evidence based are recruitment strategies to randomized controlled trials in primary care? Experience from seven studies.Family Practice. 2003; 20: 83-92
- Troubling trend: more states hostile to abortion rights as middle ground shrinks.Guttmacher Policy Review. 2012; 15: 14-19
- Patterns of patient enrollment in randomized controlled trials.Journal of Clinical Epidemiology. 2001; 54: 877-883
- The conflicting roles of clinicians versus investigators in HIV randomised clinical trials.Culture, Health & Sexuality. 2001; 3: 67-79
- Why is recruitment to trials difficult? An investigation into recruitment difficulties in an RCT of supported employment in patients with severe mental illness.Contemporary Clinical Trials. 2009; 30: 40-46
- Changes in abortion rates between 2000 and 2008 and lifetime incidence of abortion.Obstetrics and Gynecology. 2011; 117: 1358-1366
- Impact of on-site initiation visits on patient recruitment and data quality in a randomized trial of adjuvant chemotherapy for breast cancer.Clinical Trials. 2006; 3: 486-492
- Abortion and mental health: Evaluating the evidence.American Psychologist. 2009; 64: 863-890
- GPs' experiences of primary care mental health research: A qualitative study of the barriers to recruitment.Family Practice. 2007; 24: 518-525
- Recruitment and retention in a multicentre randomised controlled trial in Bell's palsy: a case study.BMC Medical Research Methodology. 2007; 7: 15
- A randomised trial of the effects of an additional communication strategy on recruitment into a large-scale, multi-centre trial.Contemporary Clinical Trials. 2007; 28: 1-5
- IMproving PArticipation of patients in Clinical Trials–Rationale and design of IMPACT.BMC Medical Research Methodology. 2010; 10: 85
- The great divide: A qualitative investigation of factors influencing researcher access to potential randomised controlled trial participants in mental health settings.Journal of Mental Health. 2010; 19: 532-541
- The comparative safety of legal induced abortion and childbirth in the United States.Obstetrics and Gynecology. 2012; 119: 215-219
- Incentives and disincentives to participation by clinicians in randomised controlled trials.Cochrane Database of Systematic Reviews. 2007; 2: MR000021
- Is there an “abortion trauma syndrome”? Critiquing the evidence.Harvard Review of Psychiatry. 2009; 17: 268-290
- Strategies to improve recruitment to randomised controlled trials.Cochrane Database of Systematic Reviews. 2010; 4: MR000013
U.S. Census Bureau. (2004). CNN election 2004. Accessed from: http://www.cnn.com/ELECTION/2004//pages/results/states/WA/P/00/county.000.html.
Biography
Loren Dobkin works as a family nurse practitioner, providing primary care to underserved communities. At the time of this writing, she was a Research Analyst for the Turnaway Study. A Leadership and Education in Adolescent Health trainee, she is interested in promoting adolescent reproductive health.
Biography
Heather Gould is the Research Manager for the Turnaway Study. She has been involved in all phases of the study, including design, implementation, analysis and dissemination. She received her Master's in Public Health from the University of California, Berkeley.
Biography
Michaela Ferrari is pursuing a Master's degree in Public Health at UC Berkeley, with an emphasis on health policy. At the time of this study, she was a Project Coordinator for the Turnaway Study and was responsible for coordinating recruitment with sites.
Biography
Rana Barar is the Project Director for the Turnaway Study. She is a dedicated public health professional with experience in research on abortion and contraception, as well as maternal mortality reduction, women's rights and sexuality education.
Biography
Elisette Weiss is currently a Senior Consulting Associate at Kaiser Permanente. She is a former Project Coordinator for the Turnaway Study and serves on the Board of Directors for Lyon-Martin Health Services. She is interested in sexual and reproductive health education.
Biography
Diana Greene Foster is a demographer who uses quantitative analyses to evaluate the effectiveness of family planning policies and the effect of unintended pregnancy on women's lives. She is an Associate Professor and the Principal Investigator of the Turnaway Study.
Article info
Publication history
Accepted:
October 18,
2013
Received in revised form:
October 17,
2013
Received:
February 13,
2013
Identification
Copyright
© 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
