Table 6 Lack of face-to-face communication between researchers and patients

Our patient and public involvement representatives felt that patient wariness was a likely reason for low patient recruitment. For example, patients could be wary about taking part in an interview which might ask them to justify their reasons for seeking emergency care, especially if they were aware that they had been seen by a general practitioner, or were told by a clinician that their condition could have been managed more appropriately by their own general practitioner.

Our co-applicants and patient and public involvement representatives also considered how face-to-face recruitment makes the research more memorable for the patient, thus improving recruitment and retention.

Because most patients were invited by post, there was little opportunity for researchers to reassure patients about the purpose of the interviews. This lack of face-to-face communication may have resulted in fewer patients recruited.

The total returns rate for face-to-face invitations (method 2) was 33%. In contrast, the total returns rate for postal invitations (method 1) was 2.5%.

While it may take more time and require more complex ethical approvals, future research should consider research designs which utilise face-to-face recruitment methods, for example using more informal interviewing methods.

Further consideration should be given to the process of consenting patients. Ensuring that this is a smooth process, for example by allowing patients to consent during their time in the department, rather than requiring consent in the post, may improve patient recruitment.