Recruiting a representative sample in adherence research—The MALT multisite prospective cohort study experience

Medication adherence is an important determinant of transplant outcomes. Attempts to investigate adherence are frequently undermined by selection bias: It is very hard to recruit and retain non‐adherent patients in research efforts. This manuscript presents recruitment strategies and results from th...

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Bibliographic Details
Published in:Pediatric transplantation 2017-12, Vol.21 (8), p.n/a
Main Authors: Shemesh, Eyal, Mitchell, Jeffrey, Neighbors, Katie, Feist, Susan, Hawkins, Andre, Brown, Amanda, Wanrong, Yin, Anand, Ravinder, Stuber, Margaret L., Annunziato, Rachel A.
Format: Article
Language:English
Subjects:
adherence
Adolescent
Child
Child, Preschool
Children
Cohort analysis
Decision Support Techniques
Female
Follow-Up Studies
Graft rejection
Graft Rejection - diagnosis
Graft Rejection - etiology
Graft Rejection - prevention & control
Humans
Immunosuppressive Agents - therapeutic use
Infant
Liver
Liver Transplantation
Male
Medication Adherence - statistics & numerical data
Patient Selection
pediatric
Prospective Studies
Recruitment
Selection Bias
transplant
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Summary:Medication adherence is an important determinant of transplant outcomes. Attempts to investigate adherence are frequently undermined by selection bias: It is very hard to recruit and retain non‐adherent patients in research efforts. This manuscript presents recruitment strategies and results from the MALT (Medication Adherence in children who had a Liver Transplant) multisite prospective cohort study. MALT sites recruited 400 pediatric liver transplant patients who agreed to be followed for 2 years. The primary purpose was to determine whether a marker of adherence, the Medication Level Variability Index (MLVI), predicts rejection outcomes. The present manuscript describes methods used in MALT to ensure that a representative sample was recruited, and presents detailed recruitment results. MALT sites were able to recruit a nationally representative sample, as determined by a comparison between the MALT cohort and a national sample of transplant recipients. Strategies that helped ensure that the sample was representative included monitoring of the outcome measure in comparison with a national sample, drastically limiting patient burden, and specific recruitment methods. We discuss the importance of a representative sample in adherence research and recommend that future efforts to study adherence pay special attention to sample characteristics.
ISSN:1397-3142
1399-3046
DOI:10.1111/petr.13067