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Motivators like health benefits, altruism, and trust in clinicians enhance participant retention and adherence in melanoma research, according to MEL-SELF findings.
Research engagement is essential to the success of randomized clinical trials (RCTs), as it influences recruitment, retention, adherence, and response rates. Studies that fail to engage participants effectively may suffer from low recruitment, adherence challenges, and high dropout rates, leading to underpowered studies, increased costs, and delayed access to effective interventions.1 Despite its importance, limited research exists on effective strategies to foster engagement across all stages of RCTs, particularly in dermatology. A recent analysis examined insights gained from a Study Within A Trial (SWAT) embedded in the MEL-SELF RCT, which focuses on increasing engagement in melanoma surveillance through patient-led approaches.2
Background
The analysis stated the engaging participants in clinical trials involves more than recruitment and consent; it extends to retention, adherence, and task compliance, all of which are critical to a study's integrity and outcomes. Researchers suggested that identifying what motivates participants to engage in trials can guide the development of targeted strategies to improve engagement. According to the PRioRiTy (Prioritizing recruitment and retention in randomized trials) study, understanding participant motivations is essential for both recruitment and retention.3 Common motivators in other clinical domains include perceived personal benefits, altruism, trust in clinicians, low burden, and financial incentives, yet these have not been thoroughly explored within dermatology trials.
The MEL-SELF RCT and the Embedded SWAT
The MEL-SELF trial out of Australia investigated whether patient-led melanoma surveillance, enhanced by smartphone-supported self-examination and teledermatology, results in earlier detection of new or recurrent melanomas compared to traditional clinician-led surveillance.2 A pilot trial highlighted challenges with participant engagement, prompting the development of an embedded SWAT to explore motivations and expectations among trial participants.4 By addressing these insights, the SWAT aimed to refine participant engagement strategies for the current trial and future dermatology studies.
Methodology and Participant Demographics
Participants in the MEL-SELF RCT were adults with a history of localized melanoma who owned a smartphone and could perform skin self-examination (SSE) with the assistance of a partner. The trial involved an active run-in phase, where participants completed a baseline questionnaire, SSE, and photo submissions of skin lesions before randomization. The SWAT examined responses from the first 100 participants who completed this phase, using content analysis of 2 open-ended questions about their motivations for joining the study and their expectations.
Of the initial 100 participants, 98 responded to the question on motivations, and 97 on expectations. The demographic profile indicated a predominantly female sample (59%), with an average age of 56 years, mostly from urban areas, and highly educated. Approximately half of the participants resided in the highest socioeconomic quintile.
Key Findings on Motivations and Expectations
Using content analysis, the SWAT identified recurring themes in motivations and expectations that highlight both general and melanoma-specific factors influencing research engagement.
Practical Implications for Future Trials
The findings from the MEL-SELF trial SWAT underscore several practical strategies for enhancing participant engagement in trials. Emphasizing perceived health benefits, such as early detection and personal health improvements, can serve as a strong motivator for participants. Researchers stated supporting altruistic goals by communicating the potential broader impact of their involvement in advancing melanoma research appeals to participants' desire to contribute to meaningful change. Building a supportive and transparent environment through regular communication fosters trust, making participants more likely to adhere to study requirements. Utilizing user-friendly technology, like smartphone-based tools for self-monitoring, minimizes the burden of participation and makes the process more convenient. Additionally, the analysis found addressing financial and logistical barriers by offering financial support, clear instructions, and reminders can alleviate practical challenges, encouraging greater retention and adherence across trial phases.
Conclusion
The analysis found improving participant engagement in dermatology RCTs, such as the MEL-SELF trial, hinges on addressing participants' motivations and reducing burdens. Insights from the analysis underscore the importance of considering both general and condition-specific motivators in trial design. Researchers suggested that tailored engagement strategies informed by participant motivations and expectations can enhance recruitment, adherence, and retention, ultimately leading to more effective and impactful dermatology research.
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