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invitationAccess to patient participants: difficulties and solutions

Authors of this page:Dawn Clarke and Graham R. Gibbs

Affiliation: University of Huddersfield

Date written: 11th August 2008

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Frances also wanted to gain data from a range of experienced doctors from those newly qualified through to senior consultants; however, this proved problematic because many of those contacted did not choose to take part and as a result she had eight participants.  

On behalf of Frances the GPs sent out invitation packs according to the recruitment criteria. Through this system she found 8 willing participants – which was a much lower number than she had anticipated- who were interviewed three times over a 12 to 18 month period using semi-structured interviews.

Loudspeaker iconHear how Frances described her difficulties in recruiting suitable participants.

So we were set on this idea of retrospective and prospective sampling and then what happened was it took a year to get it all, I couldn’t believe this, my goodness it took a nearly a year to recruit eight patients to take part. In actual fact there were 35 invitations sent out, because I got a couple fairly quickly [willing participants] I, thought oh that’s great I’m off, and then it got really slow and I’m thinking oh my goodness, you know, what am I going to do? It’s [the research] going to take me forever. I really didn’t expect that I really thought that there would be 30 patients and that would be it, by December I’d be well on me way. Oh no, oh no. It was like August, nearly, it was 10 months later when I got the final eight participants.


What Frances experienced was not unusual. Time and the number of willing participants are elements that need to be taken into consideration in the research design. One issue is the sheer time it takes to recruit participants, but the researcher also needs to minimise the time that has passed since the events respondents are asked about. Moreover, Frances had realised that it sometimes took so long for the full effects of the whiplash injury to develop that talking to sufferers over a long time period was necessary.
The number of participants has an impact on the overall applicability and richness of the study and can affect the approach to the data collection. Frances used semi-structured interviews in her data collection and she changed the time scales for the different interviews extending them, as she put it, prospectively from 12 to 18 months. This enabled her to extract more information, especially about longitudinal changes, from the interviews. 

Loudspeaker iconHear Frances talk about the frustration of waiting for willing participants and what she did to help the process.

Because the GP practices were sending out the invites, I used to write every month and say tell me what’s going on. I had no idea whether an invite had been sent out, I’d no idea at all, so you’ve got to hold all that. So after a few months what we did was, I wrote to the GPs, I was also thinking oh God ethics, do I have to go back to them now, I’m gonna approach them slightly differently ‘cos once you’ve got your ethics it does tie you down somewhat to what you’re actually able to do and we thought, we can ask the GPs to send out a letter to all those people that have been sent an invitation asking them if they want to take part, so on this point we asked them if they didn’t want to take part to let us know so we opened that up and then I got some more replies.


What Frances encountered is not unusual. Often it is necessary to access participants through a third party for reasons such as confidentiality, accessibility, ethics and so on (see here for Frances' discussion about ethical considerations). All of this puts up barriers between the researcher and the participants. Frances tried to overcome some of these difficulties by keeping in touch with the GPs on a regular basis to remind them about the research, but ultimately she also had to alter her approach. She chose to ask for replies only when patients did not want to participate rather than when they did and this allowed her to access a larger number of patients.


You have now seen the beginnings of Frances’ research project and the different elements that she needed to take into consideration and understand in order to develop the research design. For Frances these were:

  • What she wanted to research and why;
  • What questions she needed to ask in order to gain relevant data;
  • Who would be able to answer those questions i.e. who would be the participants;
  • How she would access the participants;
  • How she would manage her own experiences and bias;
  • The development of the research design;
  • Potential barriers and how she would overcome them during the research process.


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The resources on this site by Graham R Gibbs, Dawn Clarke, Celia Taylor, Christina Silver and Ann Lewins are licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.


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