It is very difficult to assess key performance indicators for recruitment- mainly due to the varying recruitment techniques and pathways used to recruit. Governance issues can largely also determine how recruitment is performed... It is possible that an individual establishing connections with referrers may go unnoticed perhaps or identified a high recruiter per say because their name does not appear on a consent form or baseline pack. In terms of RCT's it is also important to maintain high follow up and recruitment methods may impact this. 

some answers may come from the participant, some from the recruiter and others from referring clinicians for example.

The reason recruitment varies hugely in rehab trials is because many recruiters simply haven't worked out, or don't  understand, why someone would want to volunteer. For instance, most recruitment campaigns run along the theme 'We're running a research project for people with XX and you've got XX'. Then clear benefits are added to the proposal such as 'we might find a cure' or ' it's really exciting and you'll meet lots of new people' or even ' we'll pay you'. However, for the majority of those being asked to participate , the reasons simply aren't good enough.

 The key lies in presenting potential participants  with a proposal in which they perceive value. The perception of value, whether it be real or abstract  is the number one factor on which they'll base their decision. However, establishing their value is a skill, and the only measure of skill is a consistent success rate.

Assessing why some people can do it and some can't is much more difficult. Some researchers make it  an incredibly easy decision for potential participants to say yes, whether they're recruiting at group meetings or at a personal one-to-one basis. Others (like most of my colleagues)are simply dreadful at it and are best kept away from the process altogether.

Thank you both. It is 'selling' in a way isn't it? 

Yes but you also need to know the access points & care pathways. The methods of recruitment specific to that study. If you have a population that have a rare disease you may need to increase access points for example. 

Good point, and made me realise I hadnt explained it well, I suppose I was talking about once people had been identified, so the success of conversion from identification to consent. One point made at Glasgow last week was accuracy of identification , should criteria be applied strictly or less so?

I think this largely depends on the nature of the study. You may discover something during the study that may require change of inclusion criteria which may mean you need to change the protocol.

Otherwise generally speaking the inclusion criteria should be followed. Some people misunderstand inclusion criteria which could actually effect the results of the study. I have been in a study whereby i had to re-screen due to misidentification. Although statistically they may show up as anomalies and be removed at some stage or another- it is probably best to remove them early as if fact you're not really measuring an effect in a specific population under certain conditions. 

I would like to share a little from my experience. I agree that the bottom-line performance indicator is number of people recruited. Possibly the ratio of people identified to people consented might give useful insights; and possibly the ratio of people consented to people dropped out might be of interest, especially in the type of rehabilitation research that requires ongoing active engagement from participants (which ties in with Gemma’s point about maintaining high follow-up rates in RCTs).

But I would like to pick up on the point of "perception of value" that Andy made, and the point of "selling" it to a potential participant. I think that there is some portion of recruitment success that can be attributed to the individual recruiter and their communication skills (polite perseverance while being sensitive to the needs of the potential participant, "watchful waiting", etc). But I would agree with Andy that it is very much about the perceived value from the point of view of the potential participant, the "what's in it for me" factor. And this is probably something that has to be addressed within the design of the study, rather than training of recruiters.

I think this could even be interpreted as a "customer care" approach, in the sense that we need to look at research participation as a transaction, a "quid pro quo", and as researchers we need to make it relevant, attractive and convenient for people to take part. Individual recruiters might have control over a small part of that, within that window from identification to consent. But I think that probably the more substantial contribution to recruitment success can be made by designing the study for recruitment success. After all, there is only so much “selling” one can do as a recruiter, if there isn’t really much in the “product”.

Personally, I think PPI work with representatives from the study target population can be invaluable in designing for recruitment success: informing the design of the PIS, identifying and addressing anticipated barriers in advance (transportation - so often a major issue in rehabilitation research), designing some "perks"/"goodies" into study participation (not necessarily financial/material benefits, but some way of giving back to study participants), thinking of maintaining "customer relations" after the initial consent, etc.

I also agree with Gemma, that it is difficult to assess key performance indicators across the board due to varying techniques and pathways. As a general tip, I would say that recruiters on the “shop floor” have the unique opportunity to be sensitive to barriers to recruitment / reasons for declining participation that are volunteered or hinted at in conversation. And study teams can benefit from that by creating a process for recruiters to raise identified barriers.