The PACE Research team are coming to the end of the second part of the PACE Programme of research; a cluster randomized controlled trial of the Steps to Success intervention. The study included 11 nursing homes in the North West and ran for nineteen months. In my last blog, I discussed our experiences of recruiting care homes to research studies; in this blog I discuss the next step, maintaining response rates and retaining the involvement of care homes.

It easy to think at the beginning of a study that once care homes have been recruited, the rest of the study will be plain sailing. The first hurdle we hit was the high turnover of care home managers. In more than one of the care homes recruited to the study the manager had moved on and been replaced in between consenting to the study and the first data collection time point. In some cases there was not much time for a handover about the study, which meant locating the study documentation and explaining the study to the new manager; or it could be that an interim manager was in post. Situations such as these highlighted the importance of having more than one contact person in the care home, such as a deputy or administrator, who could carry on the study even if a manager was not in post.

In care homes randomised to the control group, a change in management was more problematic. It is important to ensure that the control group are provided with enough information about the study to ensure informed consent, but without providing too much detail on the intervention. In the PACE study, if a care home in the control group decided to undertake palliative care training during the study period, the research team would record this, but we did not provide any  materials for the PACE Steps to Success Intervention so as  not to bias the study. In the timings of the study, there was a twelve month gap between the first and second data collection point.

In future, we will make sure that the research team were in contact with the control care homes at regular intervals; this could be through a newsletter or a postcard to remind the manager about the study. A newsletter with anonymised response rates can create a healthy sense of competition between sites. We will also ring up at regular intervals to check key staff members were still in post.

In addition to ensuring an ongoing relationship with managers, we will try to keep staff on board too. If there is a long period of time between contact points, the research team could give presentations on the study to staff to keep them aware of the research. Care homes are busy, high-pressured environments and finding time to attend presentations is difficult. Combining a presentation with a staff meeting and bringing an incentive, such as biscuits or cake, advertises the study, provides time for staff to fill in questionnaires and an opportunity to ask questions about the study.