Who cares about recruitment anyway?

Editorial Who cares about recruitment anyway? This editorial is the result of a major disagreement between the editor and the reviewers. In this case the reviewers were strongly in favor of publishing the article by Toobert, Strycker, Glasgow, and Bagdade, ``If you build it, will they come? reach and adoption associated with a comprehensive lifestyle management program for women with type 2 diabetes'' [Pat Educ Couns 2002;xx:xxx±xxx]. On the other hand, the editor had serious reservations. The debate stemmed from the question, is it enough to just publish on recruiting and retention? Much to her credit, Dr. Hall agreed to publish the article and at the same time asked the reviewers for the following editorial. This is the peer review process at its very best. Historically, in the past when patient education interventions had little evidence of effectiveness, recruitment and retention were of little importance. However, in the last dozen years we have established the effectiveness of many patient education interventions, some of which are now widely disseminated. This leads to the question is this effectiveness limited to the few that volunteer or to the generalized population? The article by Toobert et al. in this issue is one of the few to recognize the importance of not only studying and presenting the study results of an educational intervention, but also presenting the recruitment and retention ®ndings. They choose to recruit from primary care practices and thus their recruitment pool probably closely mirrors the general population in the area served. One must be careful to note that these ®ndings may not apply to other ethnic groups or those with low educational levels; nevertheless the authors should be congratulated on so well de®ning their population, recruitment strategies, recruitment and retention. Thus, the reader has the informa- tion to make decisions about this intervention as well as apply the strategies to interventions of their own. The effectiveness of recruitment and retention has importance for research, clinical practice and policy. Let us examine each of these. Without adequate endpoint data, a study risks the possi- bility of insuf®cient power. All too often, studies are designed based on the potential population, rather than on realistic expectations of how many people can actually be recruited. Another problem is that differential dropout across groups can introduce selection bias in the follow up phase. In this era of cost effectiveness and ``downsizing,'' researchers must remain aware of the socio-cultural, demographic, and other in¯uences that may affect an individual's decision to enroll in and complete a clinical research trial. Therefore, incorporating retention strategies into the early stages of a study design maximizes the ultimate success of a trial. Similarly, issues of recruitment and retention are also critical to practice. Findings from studies such as the one reported by Toobert et al. can provide guidance and insight into strategies that can be useful for helping patients commit to treatment plans and once committed to continue with treatments. Indeed more investigators should be encouraged to publish intervention speci®c recruitment and retention strategies that can be used in clinical practice. Finally, knowledge about recruitment and retention has important implications for policy makers. Once an intervention has been demonstrated to be effective, its dissemi- nation depends to some extent on the numbers of people who will actually participate. If the study population is very selective, or if only a very small portion of the potential population wishes to participate, then the value of the intervention must be questioned. In conclusion, in answer to the question ``So, who cares about recruitment anyway?'', we respond, We all must! Erika S. Froelicher * Department of Physiological Nursing School of Nursing and Medicine University of California, Room N631 P.O. Box 0610, 2 Koret Way San Francisco, CA 94143-0610, USA Department of Epidemiology and Biostatistics School of Nursing and Medicine University of California San Francisco, CA 94143-0610, USA * Corresponding author. Tel.: 1-415-476-4833 fax: 1-415-476-8899 E-mail address: [email protected] (E.S. Froelicher) Kate Lorig Stanford University School of Medicine Stanford, CA, USA Patient Education and Counseling 48 (2002) 97 0738-3991/02/$ ± see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII:S0738-3991(02)00168-4

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Who cares about recruitment anyway?