Implementing a Prospective Study of Women Seeking Abortion in the United States: Understanding and Overcoming Barriers to Recruitment

  • Loren M. Dobkin
    Affiliations
    Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California

    Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, California
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  • Heather Gould
    Affiliations
    Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California
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  • Rana E. Barar
    Correspondence
    Correspondence to: Loren M. Dobkin, FNP, RN, MPH, C/O Diana Greene Foster, PhD, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, 1330 Broadway, Suite 1100, Oakland, CA 94612. Phone: (510) 847-5925; fax: (510) 986-8960.
    Affiliations
    Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California
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  • Michaela Ferrari
    Affiliations
    Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California
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  • Elisette I. Weiss
    Affiliations
    Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California
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  • Diana Greene Foster
    Affiliations
    Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California
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      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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      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.