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Pragmatic trials are designed to test the effectiveness of an intervention in a real-world setting, which requires decentralized enrollment and data collection methods. Communication strategies may play an important role in supporting participant engagement, though evidence describing their implementation and impact in pragmatic trials is limited. The purpose of this study was to describe the impact of various communication strategies with participants on the rate of enrollment, baseline data completion, and retention rates in the Fibromyalgia TENS in Physical Therapy Study (FM-TIPS).
Methods:
We evaluated enrollment, baseline data completion, and retention in relation to implementation of different communication strategies for FM-TIPS, a cluster randomized pragmatic clinical trial. Communication strategies evolved iteratively over the course of the trial, ranging from automated reminders to reactive and proactive personalized contact by study staff.
Results:
Following implementation of the reactive communication plan, enrollment increased from 83% to 92%, and completion of Day 1 research homework increased from 67% to 81%. Following implementation of the proactive participant onboarding approach, including a welcome phone call and email, completion of Day 1 research homework increased to 89%. Retention at later time points improved following the introduction of automated reminders combined with targeted, personalized contact. Additional communication unrelated to enrollment and completion of research homework, such as troubleshooting technical issues, may have contributed to participant retention in the study.
Conclusion:
The addition of personalized communication strategies to regular automated reminders was associated with higher enrollment, baseline data completion, and participant retention in a decentralized pragmatic trial.
Voluntary mental health support services play an important role in public health. However, long-term retention of volunteers is a major challenge. The present study aimed to understand the reasons for reduced volunteer engagement and retention loss in a UK mental health charity. Twenty-two participants from two populations (new volunteers and leavers) were engaged in semi-structured interviews to (1) longitudinally explore new volunteers’ expectations and experiences in their new role; and (2) explore reasons for stopping volunteering. Using constructivist grounded theory, we found key barriers to engagement among volunteers in this sector: unmet needs and values, unclear or demanding commitments, and reduced confidence in the role. Addressing these barriers through clearer expectations, stronger social connection, and processes that build confidence and coping (e.g., additional training) may enhance engagement and retention. Our findings suggest areas where targeted adjustments could enhance volunteer engagement and retention.
Recent years have seen record numbers of applications to UK psychiatry training, yet consultant vacancies remain high and substantial workforce gaps persist. This contradiction reflects a growing recruitment–retention paradox: increasing pressure at the point of entry has not translated into sustainable workforce capacity. This feature introduces the pressurised leaky funnel, a systems-based conceptual model that reframes the psychiatry workforce as a pathway shaped by upstream recruitment pressures and downstream attrition across five stages: exposure and intent, application, selection, training environment and career outcomes. Drawing on established workforce models and educational psychology theory, the model explains how application volume can expand while misalignment, motivational erosion and identity strain drive cumulative workforce loss across the pipeline. We argue that recruitment, selection and retention should not be treated as separate policy domains but understood as interacting components of a single system. By linking where doctors enter psychiatry with how commitment is sustained or eroded, the model offers a framework for moving beyond short-term recruitment metrics towards progression, retention and long-term workforce sustainability, while highlighting new opportunities for selection reform, training environment redesign and retention-focused workforce planning.
There are growing efforts to recruit and retain individuals from various populations in clinical trials to increase trial representativeness. Nonetheless, these challenges can hamper the development of clinical trials, contributing to increased inequities. This study explored the barriers and facilitators of participating in a mobile health trial designed to improve blood pressure (BP) among Blacks with uncontrolled hypertension from underserved communities.
Methods:
Participants were recruited from a larger mHealth clinical trial, MI-BP, across emergency departments, mobile health units, and community-based settings. We conducted an explanatory sequential mixed methods design to quantitatively examine participants’ experiences with the MI-BP trial including satisfaction and reasons for dropping out. The qualitative semi-structured interviews expanded on participant experiences based on the quantitative results. Quantitative and qualitative results were integrated to provide a more comprehensive understanding.
Results:
Fifty-two participants completed the survey and a subset of 22 were interviewed. There were no statistically significant differences on reasons for joining the MI-BP study regardless of study completion. Participants were generally motivated to learn about ways to improve their BP, with many noting positive experiences, including completers and non-completers. Some who dropped out indicated meeting their goal of lowering their BP. Despite a robust consent process, some in the non-completer group reported not understanding certain components of the study compared to the completer group. Additional barriers included concerns over adverse effects and missing worktime.
Conclusion:
Findings illuminate the barriers and facilitators participants encountered in the MI-BP trial and provides considerations for reducing barriers among this population.
Recruitment and retention challenges continue to hinder the success of clinical trials. Artificial intelligence (AI) has emerged as a promising means to optimize various clinical trial processes; however, its impact specifically on recruitment and retention has not been comprehensively evaluated. This scoping review utilized the Joanna Briggs Institute framework and adhered to PRISMA-ScR guidelines, systematically searching literature published between January 2018 and June 2024 across multiple databases. Of the 21,573 records screened, 121 studies were included. A meta-analysis was conducted to quantitatively assess the performance of AI-driven tools. AI applications for patient screening demonstrated strong performance, achieving a pooled sensitivity of 0.91 (95% CI: 0.84–0.95) and an area under the curve (AUC) of 0.79 (95% CI: 0.72–0.85). AI tools employed for eligibility identification and classification also exhibited strong outcomes, with pooled sensitivities of 0.80 (95% CI: 0.76–0.84) and 0.92 (95% CI: 0.84–0.96), respectively, and precisions of 0.84 (95% CI: 0.80–0.88) and 0.91 (95% CI: 0.85–0.95). AI tools aimed at identifying patient cohorts showed moderate effectiveness (pooled sensitivity: 0.70 [95% CI: 0.52–0.84]; AUC: 0.74 [95% CI: 0.61–0.84]). Overall, AI presents significant potential for enhancing clinical trial recruitment and retention, with effectiveness varying across specific applications. These findings underscore AI’s valuable role in improving trial efficiency and data quality.
Achieving enrollment goals is essential for the successful completion of a clinical trial. This includes enrolling a sample size that provides adequate power and engaging a study population that supports generalizability of research findings. Yet, trial participation is routinely hindered by its complexity, associated risks, and frequently cited barriers to participation including lack of awareness, low trust/mistrust, and logistical burdens that make participation of low value or unrealistic to potential participants [1,2].
In randomized clinical trials, participant retention is critical to ensure the validity and unbiased interpretation of study results. Within a multisite trial of individuals with high impact chronic pain, we explored whether a letter mailed in advance of follow-up study assessments at 3-, 6-, and 12-months from randomization improved participant retention. 4063 advance letters were mailed to 2037 participants at least once throughout their study participation. Increases in participant retention and follow-up assessment rates were observed across all study groups, sites, and timepoints. Mailing a letter in advance of follow-up study assessments in this randomized clinical trial improved participant retention.
Recruitment and retention of populations with limited prior participation in clinical trials remains a challenge. Thus, an increased understanding of the complex factors that impede or facilitate recruitment and retention is needed. Adapting the Systems Engineering Initiative for Patient Safety (SEIPS), we developed the Systems Engineering Initiative for Participant-Centric Research (SEIPR) framework that researchers can use to develop, implement, and evaluate interventions to increase trial participation.
Methods:
We performed a non-systematic literature review using the digital databases PubMed and Google Scholar to determine factors facilitating and impeding involvement of populations with limited prior participation in clinical trials. From this literature, we developed the SEIPR framework by applying it to the context of recruitment and retention.
Results:
We organized key obstacles and evidence-based solutions into five framework components: Person, Tasks and Tools, Technology, Physical Environment, and Organizational Conditions. Common obstacles included lack of awareness of active trials by participants and healthcare providers, patient’s distance from trial centers, lack of access to traditional advertising technology, and mistrust towards investigators, among others. Solutions included promotional strategies appropriate to the regional or social context, decentralizing trials, providing communication technology to participants, partnering with trusted members from the participant’s community and primary care team, using local connections and community centers, financial incentives, and transportation solutions.
Discussion:
The SEIPR framework presents a promising tool for investigators interested in increasing participant breadth in clinical trials. Future research is needed to explore real-world applications and assess its effectiveness in recruiting and retaining broad populations.
Racial targets are nonbinding, voluntary statements about goals to hire, retain, or promote people of color in the future. This chapter examines how companies have used racial targets and assesses the role of racial targets as part of the broader project of using race-conscious disclosures to show concern for and action toward addressing racial inequality. The chapter also discusses how companies attempted to meet their racial targets and argues that some corporate strategies to do so may have further entrenched racial inequality. The chapter illustrates the potential tensions between the positive aims of disclosures and their potential challenges for racial progress.
In the last twenty-five years there has been a significant alteration in the student experience in the UK. In the early 1980s it was rare for students either to fail to take exams or produce assignments on time or for them to fail to complete the degree they had begun. Now a significant proportion of students who start a programme of study withdraw before completion and this ‘attrition’ has become a particular problem for some universities and for the higher education funding bodies. This article reports the results of a project that conducted qualitative, depth interviews not focussed so much on finding reasons for having left, but rather on the experience and biography of those facing problems and thus likely to consider leaving or being forced to leave. A particular focus of this approach was to investigate a different dimension of the issue: student motivation for studying.
Massive open online courses (MOOC) have been considered by some observers as a powerful opportunity to improve distant learning. The Université catholique de Louvain was the first Belgian university to deliver a political science MOOC (Louv3x) in French, entitled ‘Discovering political science’ (Découvrir la science politique). This paper seeks to explore the challenges a pedagogical team faces when transforming a ‘traditional’ political science introductory course into a MOOC. The paper also explores how the use of a MOOC might impact the learning outcome within on-campus and worldwide students.
Engagement is a positive psychological state that is linked with a range of beneficial individual and organizational outcomes. However, the factors associated with volunteer engagement have rarely been examined. Data from 1064 volunteers of a wildlife charity in the United Kingdom revealed that both task- and emotion-oriented organizational support were positively related to volunteer engagement, and volunteer engagement was positively related to volunteer happiness and perceived social worth and negatively related to intent to leave the voluntary organization. Consistent with theory, engagement acted as a mediator between these factors. The implications for future research and the relevance of the findings for voluntary organizations are discussed.
Despite the benefits of volunteering to the individual, organization and community, the retention of volunteers within volunteer and not-for-profit organizations remains a significant challenge. Examining the motivations of individuals who have ceased their engagement in a volunteer organization may provide insights to improve retention rates. The perceptions of 64 volunteers formerly involved in an international volunteer organization were examined through community telephone interviews and online surveys. Results show that while volunteers valued their participation in the volunteer organization, their decision to cease engagement in the organization was driven by five major themes: ‘Work overload and burnout,’ ‘Lack of autonomy and voice,’ ‘Alienation and cliques,’ ‘Disconnect between volunteer and organization’ and ‘Lack of faith in leadership.’ Strategies to improve and refine organizational practice and culture may contribute to a strengthened membership and retention.
In this article, we are concerned with the recruitment potential of one-off episodic events for attracting and retaining volunteers. Our specific focus is on the neglected pool of non-returning volunteers. These are one-off event participants who are unwilling to volunteer again in future. Many studies generally document an overwhelming willingness of people to repeat volunteering after participating in a one-off event, either due to reasons of social desirability or because they had a good volunteering experience. The positive participant reaction at most one-off events leads to the assumption that such events are useful arenas in which to generate a pool of potential repeat volunteers. Yet, scant attention is given to those people at the events who have no inclination for further volunteering. This article addresses that gap. It is part of a special issue on episodic volunteering from an international perspective and uses data from nineteen countries across the world. Our statistical analyses, which compares returning and non-returning volunteers, finds that on average, 7.42% of episodic event participants do not want to volunteer again in future. The results reveal that younger, less educated, novices who participate on their own are more likely to report unwillingness to repeat volunteering. Non-repeat volunteers unexpectedly had higher levels of altruistic motivation, and as expected, a less satisfactory one-off volunteer experience. The article concludes with implications and recommendations for organizers of events employing episodic volunteers.
Retaining engaged volunteers is crucial to many non-profit organizations. However, research on volunteer engagement is limited, and the distinction between job and organizational engagement in volunteers remains to be investigated. In this paper, we examine both organizational- and job-level engagement, and specifically, whether perceived organizational support would enhance volunteer engagement and associated attitudes. We surveyed 221 volunteers, and asked them about their perceptions of organizational support; their engagement with their volunteer job and the organization they volunteer for; satisfaction; commitment; and turnover intentions. Both organizational and job engagements had significant relationships with the attitudinal variables. However, we found that organizational rather than job engagement mediated the relationship between organizational support and volunteer satisfaction and commitment. While organizational engagement correlated with turnover intentions, neither job nor organizational engagement mediated the relationship between support and the intent to leave. Our findings advance the research on volunteer engagement, and highlight the importance of organizational engagement for this important, but too often overlooked, workforce.
Chronic pain research studies are important for both finding new treatments and improving existing treatments for individuals with chronic pain. For clinical trials to be effective, participants need to be engaged and willing to participate in treatment groups. Our research applies the theory of planned behavior (TPB) to understand how attitudes, perceived social norms, and perceived control over intervention engagement are associated with willingness to participate in interventions for chronic low back pain (CLBP).
Methods:
Adult Michigan Medicine patients were identified using electronic medical records and emailed a link to an online, cross-sectional survey. Participants who self-reported CLBP, ability to read and write in English, and consented to participate were able to complete the survey (N = 405).
Results:
The results showed more positive attitudes, positive social norms, and higher perceived behavioral control related to specific chronic low back pain interventions are associated with greater willingness to participate after controlling for demographic and pain-related characteristics.
Conclusion:
The findings suggest that TPB constructs may be useful in guiding recruitment efforts for chronic pain intervention trials.
To provide insights into the motivations, challenges, and preferred methods of contact that influence the recruitment and retention of young adults (YAs) in health research.
Methods:
We designed, collected, and analyzed two surveys targeting YAs aged 18–39 years through the Amazon MTurk platform, to assess factors influencing recruitment and retention in health studies. The recruitment survey (n = 477) examined initial engagement motivations, while the retention survey (n = 473) explored factors that sustain long-term participation. Descriptive analyses were stratified by age group and sex.
Results:
The recruitment survey indicated that 88% of YAs were willing to participate in health studies, with a preference for online formats (78%). Social media, particularly Facebook (53%), was endorsed as the most common platform for discovering research opportunities. Monetary incentives were reported as the top motivator across all age groups, especially for those aged 35–39 years, with gift cards endorsed as the most appealing to participants aged 18–34. Retention survey results indicated that email (100%) was the most preferred method for maintaining engagement, followed by text messages (78.9%) and social media (62.2%). Text messages (65%), regular updates (56%) and sharing of study results (54%) were identified as key factors for maintaining participant engagement.
Conclusion:
Our findings identify that YA participation is driven by a mix of altruistic motivations, such as contributing to the community and research, and personal motivations, including personal health benefits and financial incentives, emphasizing the need for strategies that address both aspects of recruitment and retention motivations.
To investigate factors influencing the recruitment and retention of adult community nurses.
Background:
The recruitment and retention of community nurses is a growing global challenge, exacerbated by aging populations and increasing demand for primary and home-based care. Across Europe, nurse shortages threaten healthcare sustainability, with high attrition rates linked to workplace pressures, inadequate staffing, and emotional exhaustion. Despite efforts to strengthen retention, many European countries struggle to maintain adequate staffing levels, particularly in community nursing.
Methods:
An exploratory qualitative approach was used with semi-structured interviews. The interview schedule was shaped by the study’s aims, a prior integrative literature review, and the ‘causal model of turnover for nurses’. Questions explored participants’ experiences of recruitment into community nursing and factors influencing retention. The study focused on registered nurses and service managers within adult community nursing organizations across diverse geographical areas.
Findings:
The study identified eight main themes influencing recruitment and retention: the perfect job, finding true self and fulfilment, alignment with organizational values, prior development and transitional experience, job dissatisfaction, shift in traditional practices, lack of compassionate leadership, and family commitments. Key factors included workplace flexibility, professional identity, job security, and organizational culture. However, challenges such as staffing shortages, lack of career progression, and increased administrative tasks were significant barriers to retention.
Conclusion:
This study highlights the multifaceted challenges surrounding community nurse recruitment and retention, emphasizing the need for targeted strategies that go beyond traditional hospital-focused approaches. While salary improvements remain crucial, broader systemic changes including workplace flexibility, compassionate leadership, and career development opportunities are essential to fostering a sustainable workforce. By addressing these factors through co-designed solutions and evidence-based policy adjustments, healthcare organizations can enhance job satisfaction, reduce attrition, and ultimately strengthen the future of community nursing.
Tension between professional obligations and extraprofessional caregiving responsibilities is one reason physician scientists leave academic medicine. The COVID-19 pandemic exacerbated this challenge by increasing caregiving demands and decreasing time spent on research as much as 40%. CARES at UAB (Caregiving Affected Research Early-Career Scientists Retention Program at the University of Alabama at Birmingham) provided “extra hands” awards to early-career physician and non-physician research faculty to hire personnel to expedite research projects already awarded but deleteriously affected by caregiving during the pandemic. Evaluation included tracking awardee publications and grants, surveying awardees, and conducting semi-structured individual in-depth interviews. CARES at UAB distributed 28 grants totaling $1,005,266. Twenty-six awardees (93% retention) remain in academia 2.25–3.25 years after award initiation. Awardees attribute over 200 manuscripts to the funding and have secured 15 new NIH K-, R-, and U-series grants. Surveys indicate improved awardee well-being and decreased caregiving burden since receipt of funding. Scientific productivity, feeling valued, sense of community, and lifeline emerged as themes from interviews. Group “listening sessions” yielded university-level recommendations around tenure and promotion, caregiving culture, and mentoring. Resource to hire “extra hands” holds promise to retain early-career physician and non-physician research faculty with extraprofessional caregiving responsibilities.