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Patel, Shireen (2024) Understanding how to recruit and retain participants to a Digital Health Intervention (DHI) for a unique service population. PhD thesis, University of Nottingham.

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Abstract

Background

Health anxiety is a debilitating condition prevalent in primary and secondary care settings. Challenges to engaging individuals with health anxiety to cognitive behavioural therapy (CBT) led to the development of a remotely delivered Cognitive Behavioural Therapy (RCBT) randomised controlled trial (RCT) (the “Urgent Care trial”) for the treatment of health anxiety for those accessing unscheduled care services. Whilst an RCT assesses overall effectiveness, the nested piece of qualitative research which forms this thesis is necessary to understand service provider and service user views of trial participation, given that recruitment and retention to trials remains a challenge.

Aims and objectives

The primary aim of this thesis was to understand factors influencing recruitment and retention to a Digital Health Intervention (DHI) trial from a service provider and service user perspective. The objectives of the thesis were:

1) To review the published literature on factors impacting recruitment and retention into depression, anxiety and somatoform DHI trials;

2) To explore service provider reasons for participating and referring patients to the Urgent Care trial, and

3) To understand service user reasons for participating and remaining or withdrawing from the Urgent Care trial.

Methods

This qualitative thesis comprises three work packages. In work package one a systematic review and meta-synthesis was conducted. Work package two consisted of interviews with 18 service providers from primary and secondary care services who had been invited to participate in the Urgent Care trial or who had been involved in referring or recruiting service user participants to the trial. In work package three, 28 interviews were conducted with service users, randomised to one of two groups; Remotely Delivered Cognitive Behavioural Therapy (RCBT) and Treatment As Usual (TAU) in the Urgent Care trial. Data was collected using purposive sampling and analysed using Reflexive Thematic Analysis.

Results

The systematic review identified 15 studies. Three main themes were identified: 1) initial motivations and approaches to DHIs, 2) personalisation of treatment and 3) support to understand DHIs. Limitations of the review included no qualitative data on somatoform disorders being included, and the limited availability of research specifically focusing on recruitment to DHIs.

Analysis of the service provider interviews led to the identification of three main themes: 1) service provider understanding and perceived credibility of the trial over existing interventions, 2) perceived benefits and costs of trial participation, and 3) risk of the trial to the service provider-patient relationship.



Analysis of the service user data resulted in the identification of two main themes in relation to recruitment: 1) initial perceptions and its impact on motivation to participate, and 2) perceived credibility of the intervention over existing treatment pathways. Three main themes were evident in relation to retention: 1) research related aspects and its impact on therapy and questionnaire completion, 2) perceived change in circumstances because of study participation, and 3) DHI factors influencing retention to RCBT treatment sessions.

The findings from all three work packages indicated that the analytical themes could both be facilitators and barriers to recruitment and retention. The thesis offers a conceptual framework highlighting the contributions from existing theoretical models on innovation adoption (noting digital delivery of health interventions was considered an innovation at the time of data collection) and the additional novel contributions uncovered by this analysis. The major finding from this is the importance of personalisation and collaborative working when developing and delivering DHI trials.

Conclusions

By combining original, empirical qualitative data and existing knowledge on the reasons for innovation engagement and adoption, this thesis offers an original contribution in understanding the factors influencing recruitment and retention to a DHI trial for health anxiety, from both a service provider and service user perspective.

These results have implications for the future design of DHI trials to improve recruitment and retention rates in research studies. Future research should explore how the constructs identified from the theoretical models’ impact recruitment and retention into DHI trials. This could involve exploring which aspects of a DHI trial are determined to be most influential in recruitment and retention, and if these are specific to DHI research, or research recruitment and engagement more generally. Further research on the unintended benefits of trial participation particularly when randomised to TAU also warrants further exploration.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Morriss, Richard Wright, Nicola Rowley, Emma
Keywords:	Digital Health Intervention; Health anxiety; Service users; Service providers; Trial participation
Subjects:	W Medicine and related subjects (NLM Classification) > W Health professions
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	78454
Depositing User:	Patel, Shireen
Date Deposited:	11 Dec 2024 04:40
Last Modified:	11 Dec 2024 04:40
URI:	https://eprints.nottingham.ac.uk/id/eprint/78454

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