Recruiting people facing social disadvantage: the experience of the Free Meds study

• Published in: International journal for equity in health 2021-06, Vol.20 (1), p.149-9, Article 149
• Main Authors: Norris, Pauline, Cousins, Kimberly, Churchward, Marianna, Keown, Shirley, Hudson, Mariana, Isno, Leina, Pereira, Leilani, Klavs, Jacques, Tang, Lucy Linqing, Roberti, Hanne, Smith, Alesha
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Australia; Chronic obstructive pulmonary disease; Clinical trials; Consent; Cooperation; Deprivation; Diabetes; Diabetes mellitus; Drug stores; Female; Health aspects; Health care facilities; Health Services; Health services research; Hospitals; Humans; Identification documents; Male; Maori; Medical research; Medicine; Mental health; Methods; Middle Aged; New Zealand; Patient Selection; Prescription charges; Prescriptions; Recruitment; Rural areas; Social Determinants of Health; Social disadvantage; Social Media; Social surveys; Socialized medicine; Socially handicapped; Study recruitment; Surveys
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-021-01483-6

Researching access to health services, and ways to improve equity, frequently requires researchers to recruit people facing social disadvantage. Recruitment can be challenging, and there is limited high quality evidence to guide researchers. This paper describes experiences of recruiting 1068 participants facing social disadvantage for a randomised controlled trial of prescription charges, and provides evidence on the advantages and disadvantages of recruitment methods. Those living in areas of higher social deprivation, taking medicines for diabetes, taking anti-psychotic medicines, or with COPD were eligible to participate in the study. Several strategies were trialled to meet recruitment targets. We initially attempted to recruit participants in person, and then switched to a phone-based system, eventually utilising a market research company to deal with incoming calls. We used a range of strategies to publicise the study, including pamphlets in pharmacies and medical centres, media (especially local newspapers) and social media. Enrolling people on the phone was cheaper on average than recruiting in person, but as we refined our approach over time, the cost of the latter dropped significantly. In person recruitment had many advantages, such as enhancing our understanding of potential participants' concerns. Forty-nine percent of our participants are Māori, which we attribute to having Māori researchers on the team, recruiting in areas of high Māori population, team members' existing links with Māori health providers, and engaging and working with Māori providers. Recruiting people facing social disadvantage requires careful planning and flexible recruitment strategies. Support from organisations trusted by potential participants is essential. The Free Meds study is registered with the Australian and New Zealand Clinical Trials Registry ( ACTRN12618001486213 ).