BMJ open · 2026
'Anything to Help Find a Cure' or 'It Doesn't Seem Worth It': an observational qualitative analysis using behaviour theory to understand motivation and barriers to observational cohort study participation.
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JaKa Meghan M, Henderson Maren S G, Fidler Samantha J, Gaudet Mia M, Ziegenfuss Jeanette Y
Аннотация
BACKGROUND: It is increasingly difficult to achieve high recruitment rates for participants in research studies. Application of behavioural theory and qualitative assessment of operational data might refine study recruitment processes. Field notes from conversations between potential participants and recruitment team members generate a rich source of qualitative data that can be leveraged to understand the theory-driven facilitators and barriers of research participation decisions and thus improve recruitment operations.
OBJECTIVES: Describe the self-reported barriers and facilitators to research participation in a large observational cohort, the Connect for Cancer Prevention Study (Connect), using the Capability, Opportunity, Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF).
DESIGN: Observational qualitative analysis of field notes documenting unsolicited comments made by potential participants during the course of recruitment phone calls.
SETTING: A health system in the upper Midwest USA recruiting patients into Connect.
PARTICIPANTS: Data were collected between January 2022 and December 2024 and include comments from 1681 individuals who both did and did not choose to participate.
MEASURES: Comments were first coded by recruitment team members as positive or negative at the time they were documented and then later coded into COM-B/TDF categories by independent team members.
RESULTS: A total of 1560 unsolicited comments were coded during the aforementioned recruitment period. The largest category of barriers was related to capability (31%, n=491 comments) including concerns about data privacy. The next most frequent code was of motivation-related facilitators highlighting the sense of value or purpose that comes from research participation (17%, n=258 comments). Barriers and facilitators, identified in each COM-B category, were intertwined in a given unsolicited comment (eg, opportunity facilitators like a social connection to someone with cancer and motivation facilitators related to research providing a sense of purpose).
CONCLUSIONS: This unsolicited comment analysis identified factors that could be aligned with research recruitment strategies to advance more efficient and equitable participation. For example, potential participants identified a personal relationship with cancer, such as having lost a loved one to cancer, as a motivation for participation. Recruitment materials could be written to frame the study as an opportunity to appeal to this motivation. This approach is easily replicable and not only advances our understanding of facilitators and barriers to Connect study participation that are immediately actionable but also enhances our understanding of the relative mechanisms of recruitment behaviour that could be useful for designing recruitment approaches for other observational cohorts.
OBJECTIVES: Describe the self-reported barriers and facilitators to research participation in a large observational cohort, the Connect for Cancer Prevention Study (Connect), using the Capability, Opportunity, Motivation-Behaviour (COM-B) model and Theoretical Domains Framework (TDF).
DESIGN: Observational qualitative analysis of field notes documenting unsolicited comments made by potential participants during the course of recruitment phone calls.
SETTING: A health system in the upper Midwest USA recruiting patients into Connect.
PARTICIPANTS: Data were collected between January 2022 and December 2024 and include comments from 1681 individuals who both did and did not choose to participate.
MEASURES: Comments were first coded by recruitment team members as positive or negative at the time they were documented and then later coded into COM-B/TDF categories by independent team members.
RESULTS: A total of 1560 unsolicited comments were coded during the aforementioned recruitment period. The largest category of barriers was related to capability (31%, n=491 comments) including concerns about data privacy. The next most frequent code was of motivation-related facilitators highlighting the sense of value or purpose that comes from research participation (17%, n=258 comments). Barriers and facilitators, identified in each COM-B category, were intertwined in a given unsolicited comment (eg, opportunity facilitators like a social connection to someone with cancer and motivation facilitators related to research providing a sense of purpose).
CONCLUSIONS: This unsolicited comment analysis identified factors that could be aligned with research recruitment strategies to advance more efficient and equitable participation. For example, potential participants identified a personal relationship with cancer, such as having lost a loved one to cancer, as a motivation for participation. Recruitment materials could be written to frame the study as an opportunity to appeal to this motivation. This approach is easily replicable and not only advances our understanding of facilitators and barriers to Connect study participation that are immediately actionable but also enhances our understanding of the relative mechanisms of recruitment behaviour that could be useful for designing recruitment approaches for other observational cohorts.