Intended for healthcare professionals

Rapid response to:

Analysis And Comment Confidentiality and consent in medical research

Overcoming barriers to recruitment in health research

BMJ 2006; 333 doi: (Published 03 August 2006) Cite this as: BMJ 2006;333:300

Rapid Response:

Investigating barriers to recruitment in health research

Hewison and Haines discuss recruitment procedures as barriers to
participation in research on health1. We were able to explore this issue
as part of a survey of the attitudes of older people to physical

887 people aged 65–84 years were invited by a letter from their GP to
participate in a home interview study. They also received an information
leaflet and a postcard to return to decline participation. Overall 54%
refused, most (384) by returning the postcard, the remainder (91) refused
when visited or telephoned. Ethical permission was obtained to investigate
the reasons for refusal to participate. After GPs excluded patients deemed
ineligible, 417 people were sent an eight item questionnaire. 60% of those
who initially refused to participate in the survey returned a
questionnaire giving reasons for not taking part. The commonest reason
(given by 56%) was that participants thought that they did not do enough
activities to be of interest to the study. The other main concern was
being visited at home by a research nurse (45%). Only 28% said they were
not interested in research.

This study confirms the importance of investigating attitudes to
participation. The high response rate among those who initially refused
indicates a willingness to participate in research. The finding that many
of those who refused did so because they thought they were not
sufficiently interesting, suggests that it was misperception rather than
antipathy to the study which prompted refusal. Tackling low response, and
the bias it may create, requires understanding and addressing the concerns
of potential participants. The requirement for opt-in systems, as Hewison
and Haines point out, exacerbates low response rates. Research should only
be undertaken when there is a high likelihood of producing valid findings.
Ethical requirements which result in invalid research may themselves be


1 Hewison J, Haines A. Overcoming barriers to recruitment in health
research. BMJ 2006;333;300-302

2 Crombie IK, Irvine L, Williams B, McGinnis AR, Slane PW, Alder EM,
McMurdo MET. Why older people do not participate in leisure time physical
activity: a survey of activity levels, beliefs and deterrents. Age Ageing

Competing interests:
None declared

Competing interests: No competing interests

10 August 2006
Iain K Crombie
Professor of Public Health
Linda Irvine, Maion ET McMurdo, Brian Williams
Ninewells Hospital and Medical School, Dundee, DD1 9SY