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A simple technique to identify key recruitment issues in randomised controlled trials: Q-QAT - Quanti-Qualitative Appointment Timing

机译:一种识别随机对照试验中关键招募问题的简单技术:Q-QaT - Quanti-Qualitative appointment Timing

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摘要

BACKGROUND: Recruitment to pragmatic randomised controlled trials (RCTs) is acknowledged to be difficult, and few interventions have proved to be effective. Previous qualitative research has consistently revealed that recruiters provide imbalanced information about RCT treatments. However, qualitative research can be time-consuming to apply. Within a programme of research to optimise recruitment and informed consent in challenging RCTs, we developed a simple technique, Q-QAT (Quanti-Qualitative Appointment Timing), to systematically investigate and quantify the imbalance to help identify and address recruitment difficulties. METHODS: The Q-QAT technique comprised: 1) quantification of time spent discussing the RCT and its treatments using transcripts of audio-recorded recruitment appointments, 2) targeted qualitative research to understand the obstacles to recruitment and 3) feedback to recruiters on opportunities for improvement. This was applied to two RCTs with different clinical contexts and recruitment processes. Comparisons were made across clinical centres, recruiters and specialties. RESULTS: In both RCTs, the Q-QAT technique first identified considerable variations in the time spent by recruiters discussing the RCT and its treatments. The patterns emerging from this initial quantification of recruitment appointments then enabled targeted qualitative research to understand the issues and make suggestions to improve recruitment. In RCT1, presentation of the treatments was balanced, but little time was devoted to describing the RCT. Qualitative research revealed patients would have considered participation, but lacked awareness of the RCT. In RCT2, the balance of treatment presentation varied by specialists and centres. Qualitative research revealed difficulties with equipoise and confidence among recruiters presenting the RCT. The quantitative and qualitative findings were well-received by recruiters and opportunities to improve information provision were discussed. A blind coding exercise across three researchers led to the development of guidelines that can be used to apply the Q-QAT technique to other difficult RCTs. CONCLUSION: The Q-QAT technique was easy to apply and rapidly identified obstacles to recruitment that could be understood through targeted qualitative research and addressed through feedback. The technique's combination of quantitative and qualitative findings enabled the presentation of a holistic picture of recruitment challenges and added credibility to the feedback process. Note: both RCTs in this manuscript asked to be anonymised, so no trial registration details are provided.
机译:背景:务实的随机对照试验(RCT)的招募被认为是困难的,而且很少有干预措施被证明是有效的。先前的定性研究始终表明,招募人员提供的有关RCT治疗的信息不平衡。但是,定性研究可能很耗时。在一项旨在优化具有挑战性的RCT中的招聘和知情同意的研究计划中,我们开发了一种简单的技术Q-QAT(定量定性约会计时),可以系统地调查和量化不平衡状况,以帮助识别和解决招聘难题。方法:Q-QAT技术包括:1)使用录音的录用任命书的笔录量化讨论RCT及其治疗所花费的时间,2)进行定性研究以了解招聘的障碍,3)向招聘者反馈有关获得工作机会的信息改善。这被应用于具有不同临床背景和募集过程的两个RCT。在临床中心,招聘人员和专科之间进行了比较。结果:在两个RCT中,Q-QAT技术首先确定了招聘人员讨论RCT及其治疗方法所花费的时间的巨大差异。通过最初对招聘职位进行量化,出现了一些模式,从而使有针对性的定性研究能够理解问题并提出改善招聘的建议。在RCT1中,治疗的表现是平衡的,但很少有时间描述RCT。定性研究显示患者会考虑参加,但对RCT缺乏了解。在RCT2中,治疗表现的平衡因专家和中心而异。定性研究显示,在提出RCT的招聘人员中,平衡和自信方面存在困难。定量和定性的研究结果受到招聘人员的欢迎,并讨论了改善信息提供的机会。在三名研究人员之间进行的盲目编码练习导致制定了可用于将Q-QAT技术应用于其他困难RCT的指南。结论:Q-QAT技术易于应用,可以快速确定招聘障碍,可以通过有针对性的定性研究来理解这些障碍,并通过反馈加以解决。该技术结合了定量和定性的发现,从而呈现出招聘挑战的整体情况,并增加了反馈过程的可信度。注意:此手稿中的两个RCT均要求匿名,因此未提供试用注册详细信息。

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