Challenges of recruitment to a trial of a psychosocial intervention for postnatal depression in British mothers of South Asian origin.

Problem

British South Asian (BSA) women are considered 'hard to engage’, in health services and research, due to language and cultural barriers. They suffer from poor health, social isolation and tend to not access available health services and treatment. BSA women with postnatal depression may lack social support, fluency in English, and the resources to seek help. Isolation and lack of social support are important elements to be addressed in interventions for postnatal depression.

Approach

This multi-centre trial aims to evaluate the clinical and cost effectiveness of a culturally adapted group psychological intervention (Positive Health Programme, PHP) in primary care for BSA women with postnatal depression compared with treatment as usual.We aimed to use qualitative methods to explore early barriers and enablers to study participation to optimise on-going trial recruiter training and trial recruitment rates. A number of recruitment methods have been employed to recruit to the internal pilot trial:Women contacted at six weeks by general practicesWomen informed about study by health visitorsResearchers attending baby clinics and Sure Start centres approach Posters in general practices, community centres and Sure Start centresTrial eligibility screening used the PHQ-9 (Patient Health Questionnaire, 9 item), with women who scored ≥ 10 invited to complete the SCID (Structured Clinical Interview for DSM disorders). Women positive on SCID diagnosis offered randomisation to the trial. Researchers documented reasons for women declining to complete the SCID or to be entered into the trial. Field notes were kept by the researchers to provide context to the reasons for declining given by women, and their families.Women who were eligible for the trial were invited to participate in a semi-structured interview to further explore reasons for declining to enter the trial.

Findings

So far, we have approached 2251 mothers: eligible 1526, screened 1036, high scorers 209, refusal at PHQ 213, refusal at SCID 14. Some women declined to give explanations for not wishing to participate in the trial. Reasons given included ‘not interested in research’, ‘no time’, ‘feel well at present’, ‘don’t wish to share personal information’. Some women suggested that the proposed group intervention did not appeal to them. Researchers noted that, in some cases, the decision appeared to be made for the woman by husband or mother-in-law.Few women agreed to participate in an interview, and those who did subsequently declined when contacted by the researcher to confirm a time for the interview.

Consequences

Understanding the barriers to women feeling able to participate in research studies will enable us to modify public-facing documents, recruitment strategies, researcher training in the main trial. Development of family-centred recruitment pathways and modification of approaches to study advertising will be considered.