Overcoming the challenges of recruiting care homes to research

We spoke to Claire Surr, Professor of Dementia Studies at Leeds Beckett University, about the early stages of the EPIC trial. She describes how the team first piloted their recruitment processes and planned a phased recruitment of 50 care homes.

Background

The EPIC trial (Enhancing Person-centred care In Care homes) is assessing whether a complex intervention called Dementia Care Mapping (DCM) makes a difference to the lives of people with dementia, as well as whether it’s cost-effective for care homes. DCM involves training staff to use an observational tool that helps them understand what receiving care is like for a person with dementia. They then share this understanding with other staff in the home, and work as a team to decide how they can improve and build on their existing good practice.

Although DCM has been in use for many years, this is the first large-scale, UK-based study of its effectiveness. The trial will assess whether DCM:

• reduces agitation and improves the quality of life of people with dementia

• impacts on residents more generally, such as reducing the need for medication or other healthcare

• increases job satisfaction and feelings of competence amongst staff.

A large sample size is required because of the complexity of both the intervention and the outcomes. The team are aiming to recruit 50 care homes, to include a range of sizes – some residential, some offering specialist dementia care and some nursing homes.

The trial started in September 2013, but the first care home wasn’t recruited until June 2014. The team allowed for several months of planning before piloting their recruitment processes. Setting up the project and full recruitment of the care homes is then being phased over a year. This gives them a much more manageable recruitment target of 3-5 homes per month, rather than trying to recruit all 50 at once. This case study describes the challenges the researchers have faced to date and how these challenges have been overcome.

Finding care homes and making contact

The design of the EPIC trial requires recruiting a random sample of care homes, as Claire described, “We’re going for every eligible home at each We spoke to Claire Surr, Professor of Dementia Studies at Leeds Beckett University, about the early stages of the EPIC trial. She describes how the team first piloted their recruitment processes and planned a phased recruitment of 50 care homes. location, not just the ones which respond to an advert, or are research-ready. Counter to expectations, we’ve found that many are keen to engage and we’ve had no problem recruiting to target.”

The team first identify all the eligible care homes in a particular location, using information in the public sphere. They place the homes in random order and then send out letters to twelve at a time. A week later, the researchers follow up with a phone-call to find out if the manager is interested, “Managers are really busy and you might have to ring a good few times before they’re able to speak to you. Even the keen ones might not respond to your letter – you have to be very proactive in making contact”, Claire explained.

Speeding up the process

Using existing networks and contacts has helped to speed up the recruitment process, as Claire described, “With big providers, when we know senior level people in the organisation, we contact Head Office at the same time as talking to local care homes. The care homes always need Head Office permission to take part anyway, so this helps move things on. It also means we can sometimes work across a number of locations at the same time.”

Explaining the research

Claire believes that being honest about what taking part involves is extremely important when talking to managers about the research, “You want people to make the right judgment about whether they’re able to participate because that’s the only way your research will be successful. You don’t want people saying yes, but dropping out later because they didn’t realise how much time it was going to take”.

Negotiating with care homes

At all stages of the research, from recruitment through to data collection, the team have found they need to flexible, supportive and understanding about the demands on care home staff. “We’ve found you have to give people the information, and then give it to them again… you have to prompt and support the process, because you have to remember that your research is not top of the list of the manager’s priorities. Their priority is to run the home”.

Piloting the recruitment process

Anticipating these challenges, the EPIC team allowed a lot of time for planning, rather than launching straight into recruitment. This included piloting the whole process by working with just a couple of homes. Claire found that, “We learnt such a lot from doing that, about what worked and what didn’t work at all. You’ve got to give yourself time to plan it properly, to pilot it properly and for everything to take a lot longer than you think”.

Key messages for care home researchers

• Don’t underestimate the time it takes to recruit care homes

• Be proactive in making contact at the same time as remembering care home staff are very busy

• Be flexible, supportive and understanding of the demands on managers and staff

• Be honest about what taking part in the project involves

• Use existing networks and contacts to help speed up the process

• Always plan to pilot your recruitment process to find out ‘what works’

March 2015

For more information contact:

Professor Claire Surr

Email: C.A.Surr@leedsbeckett.ac.uk