Understanding the study recruitment behaviour of Health Visitors and Community Midwives: an application of the Theoretical Domains Framework

Background: Poor recruitment is a widespread problem in health research, especially for studies recruiting children and families in community settings. The Theoretical Domains Framework provides a theory-based lens through which recruitment behaviour can be understood, with a view to developing theory based strategies to improve recruitment. Aim: To explore influences on study recruitment behaviour of health visitors and community midwives. Method: Health visitors and community midwives working in England in four NHS Trusts and one Community Partnership were invited to take part in the study. Participants completed a self-reported, anonymous, online, cross-sectional survey with questions about recruitment behaviour adapted from the Theoretical Domains Framework. Qualitative data from open-answered survey questions were analysed using directed content analysis. Results: The survey was completed by 114 health visitors and community midwives (37% response rate).Two theoretical domains were identified for over 75% of respondents: Goals (conflict with/precedence of other goals) and Beliefs about consequences (positive beliefs of contributing to evidence for improved care, negative beliefs about risking patients’ clinical outcomes and wellbeing). Three other theoretical domains, Social/professional role and identity (particularly beliefs about the caring role), Intention (to inform patients about research) and Knowledge (about the background and purpose of the study) were also identified as influencing recruitment behaviour. Conclusions: For English health visitors and community midwives, competing priorities, beliefs about negative consequences of research, conflict with a valued caring identity and insufficient knowledge about the study purpose and background all appear to influence their study recruitment behaviour.