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Table 4 Recruitment barriers and enablers reported by GPs in free text boxes

From: Barriers and facilitators to patient recruitment to a cluster randomized controlled trial in primary care: lessons for future trials

Theme Example
Patient level barriers (perceived by GP)  
Patient unwilling to participate “Patients who were well controlled on [Diskus] and Turbuhalers were very reluctant to change over to Seretide [Advair] MDI and about 3 patients refused to enter study for this reason.”
Patients unavailable to participate “Some patients were geographically unavailable: [they worked as fly-in-fly-out employees in mines in Western Australia], some changed address.”
GP level recruitment barriers  
Few eligible patients perceived by GP “I don't think you could have done any more. I guess most of my patients have well-controlled asthma!”
Difficulty prioritizing research due to perceived demands of study or time constraints “You did a lot to assist recruitment. The excessive amounts of work involved put us off the desire. We then did not give much effort.”
Confusion about recruitment information “When invited to participate I agreed because I had patients on Symbicort and Seretide. Unfortunately by the time I entered the study only Seretide was an option. I was not prepared to swap patients off Symbicort (my drug of choice).”*
Study thought to be too intellectual or confronting for patients “I feel your program is too intellectual for ordinary patients who find instructions too difficult and give up & avoid anything too confronting and being shown up by other parties is unhelpful.”
Confusion around disease diagnosis and management “Asthma/COAD i.e. Patient was diagnosed with asthma in the past and later diagnosed with COAD by specialist.”
Practice/organization level barriers  
GP not empowered to recruit within a group practice “I had a poster in my [office], this did result in some patients volunteering when they read [the] notice (our waiting room is very large and we are prohibited to putting up such posters).”
“As I am a new GP here I could not/did not try to recruit other doctor's patients into the study. I did not want to take other doctors patients unless they spontaneously moved to see me”.
Study level barriers  
Need for more recruitment support “If a personnel from MICA was sent to help with recruitment that will be a great help for us or for future sites.”
Study materials needed in languages other than English “I have a lot of patients with limited English, explanation (how to use spacer etc.) in [a language] other than English will help for some.”
Lack of incentive for patient “It was very hard to convince the patients to participate. [There was] not much incentive.”
GP level recruitment enablers  
Good recruitment support “No! The support and induction processes were excellent.”
Study perceived as beneficial to GPs practice “MICA study was beneficial personally in learning some new techniques and also had satisfaction [in] that it helped my patients in many ways to improve control and understand their condition.”
  1. *Note - there was no change in the inclusion criteria; the need to switch patients taking another medication at entry was clearly stated during the workshop and in the study materials.