Question

Describe three techniques, methods, or recommendations you can use to promote retention in a study

Answer 1

Recruitment of an adequate number of participants, although essential, does not in itself assure the success of a study. Once participants are recruited into a study, they must complete the study to ensure their information/data can be included in the final analysis. Unless an adequate number of participants are retained for the duration of the study, investigators may not obtain enough data to answer the research question they posed, which was the reason for performing the study in the first place. Also, the cost (in time and resources) of retaining and managing a participant who is already enrolled is considerably less than the cost of recruiting a new participant.

Retention means assuring that participants:

• Undergo study procedures at the required intervals.
• Complete questionnaires or responses to interviewers’ questions.
• Participate in any other activities required by the study protocol.
• Attend follow-up visits as required.

Elements of a Successful Retention Strategy Successful retention involves:

• Treating the participant with respect.
• Being considerate of the participant’s time.
• Identifying and overcoming barriers to retention.
• Including retention strategies in the budget.
• Identifying and resolving problems in a timely manner.

Retention Begins with the Participant’s First Visit During the first visit, while the participant is going through the informed consent process ensure the participant understands the time and procedures involved and talk about why it is important to complete all the required study procedures and visits. Often, study templates or electronic CRFs are created to record a participant’s contact information, also called locator forms. Using a locator form, the study staff may record the participant’s address, phone number, and contact information for friends and family members who may be called, of course, with the consent of the participant. This information will help the clinic to locate the participant later if he or she misses a visit.

Retention is an Ongoing Process Do not wait until the last participant is enrolled before starting to think about retention. Devise retention strategies during the study design phase. Depending on the population being studied, it may be beneficial to review the participant’s contact information with him or her at every visit. For example, many drug-dependent individuals change their home address or job frequently. Ensure that up-to-date contact information is always on file for every participant.

Retention is Everyone’s Responsibility All clinic staff should be trained to understand the importance of maintaining up-todate contact information for all participants. A participant may casually mention at any time that he or she is about to move, change jobs, or change his or her marital status. This information should be recorded in the participant’s file and communicated to all members of the research team.

Specific Strategies for Retaining Participants in a Clinical Study Stress the importance of compliance during the informed consent interview and throughout the study.

• Establish rapport with participants.
• If a participant cannot be found and has not withdrawn consent, use the participant's contact information to try to find him or her. Telephone the participant’s home, telephone his or her contacts, or (if the participant has given consent for home visits) visit the participant’s home.
• Use public information to try to locate the participant. For example, in some states, the motor vehicle administration and other government agencies will release an individual’s contact information if it is considered to be part of the public record.
• Consider amending the protocol to ease or eliminate assessments or other procedures that participants find disagreeable and that may deter retention.
• Use regular teleconferences to brainstorm retention strategies with local and national project staff.
• Send reminder notes to let the participant know you will be calling shortly to perform or schedule their next assessment.
• Conduct research interviews at a location convenient for the participant.
• Offer participants transportation to and from the study site.
• Be persistent and document all attempts to contact participants — keep trying.
• Ensure that all of these efforts preserve the privacy of the participant.