gms | German Medical Science

Background: Chronic work-related stress is a major burden among German general practitioners and practice assistants. The IMPROVEjob-study, funded by the German Federal Ministry of Education and Research, was designed to improve job satisfaction and reduce work-related stress in practice personnel using a multimodal participatory intervention. To effectively improve job satisfaction, the target group needs to participate (recruitment) yet not be burdened by the intervention (dose). The IMPROVEjob project applied a participatory design and included practice personnel from the beginning and throughout the project. The intervention designed comprised three workshops (one for GPs only, two for GPs and their practice teams), a toolbox and a 9-months-support by IMPROVEjob facilitators. For the cluster-randomized trial, a total of 56 practices needed to be recruited. Here, we report the results of the recruitment process as an example for experiences with a highly strained target population.

Questions: What experiences were gathered during the recruitment process for the effectiveness study? Which adjustments were needed to successfully address the target group?

Methods: During the 6-months recruitment process (9/19–2/20) reasons for non-participation were collected systematically by non-responder faxes. In addition, results from phone calls with the target group were noted. Six weeks after beginning the recruitment, the participation rate was poor, necessitating a reevaluation of the recruitment strategy and the planned intervention by analyzing the available data.

Results: Reasons for non-participation could be assessed for n=288 practices. The results were supplemented by notes of verbal information provided by phone calls with the target group. Two of the most frequent reasons for non-participation were the time required to attend the three workshop afternoons and the travel distance to the workshop location. Especially the practice assistants considered the two workshops as too time-consuming.

Discussion: The analysis of available non-responder faxes as well as notes from phone contacts provided the solution for the recruitment problems: the number of workshops was reduced from three to two, and an additional location was offered. These adjustments led to a successful recruitment of the target number of 58 practices.

Practical implications: In larger intervention studies addressing populations with high chronic work-related stress it is crucial to explore the participants´ willingness to invest time and other resources. Non-responder analyses are a useful strategy to identify barriers for participation.