Finding trials for participants: an ethnographic study of successful recruitment strategies for clinical trials

Finding participants is one of the main barriers to the timely and successful running of clinical trials. Poor recruitment can lead to many issues, such as delays, which often leads to greater financial resources being put into the trials. We explore how a clinical trial centre with a good recruitment record is able to find participants for trials through successful innovative strategies. Ethnographic observations were conducted over a 17-month period at a clinical trial unit in London, UK, supplemented with semi-structured and ethnographic interviews with staff and participants. Observations focused on three hypertension clinical trials, including screening and pre-screening visits for them. Overall, the dataset included 353.5 h of observations, 322 min of semi-structures interviews, and ethnographic interviews not recorded. It was found that The Centre engaged in innovative strategies by reversing the traditional logic of recruitment. As well as engaging in the traditional model of trial recruitment (1-4), where participants were found for specific trials (such as radio, newspaper, and social media adverts, and recruiting from other healthcare settings), The Centre reversed the logic and found trials for participants, a similar logic to how trial-matching platforms work. This was done by offering participants a range of trials when they first came to The Centre and offering other appropriate trials when they had finished the ones they were on. This reversed logic changed the nature of suitability of a participant to not only be someone eligible, but someone who staff would want and appreciate. Trouble recruiting for clinical trials is a perennial problem. Understanding how a successful centre recruits by reversing the logic of recruitment may allow other settings to attempt this to boost numbers and representativeness on trials. This opens up areas of future research to systematically test these methods.