Table 2 Suggested Solutions to Research Challenges
From: Challenges of conducting research in long-term care facilities: a systematic review
Challenges | Specific Issues | Suggested Solutions |
|---|---|---|
Facility/owner/administrator factors | Recruitment & retention of facilities | - PI develop long-standing relationship with LTC facility [24, 47] - Establish LTC research network [49] - Target facilities with history of research participation [47] - Provide continuing education opportunities to staff |
- Unfamiliar with research - Not interested - Feel threatened | - Improve education for owners and administrators [25, 26, 49] - Share research ownership [24, 47] - Include administration in study design and development | |
Resident factors | - Recruitment - Consent - Lack of trust - No personal benefit - Invasion of privacy | - Carefully designed, concise, and easy to understand recruitment materials [24, 43] - Assure privacy despite difficulties [43] - Emphasize to residents that their decision will not affect relationship with staff [42] - Offer financial compensation [42] - Develop flexible recruitment criteria [28] - Have trained home staff members do the initial approach for participation |
Prefer treatment over placebo | - Double-blinded, cluster randomization [27, 46] - Educate residents about the benefits of participation e.g. more intense monitoring | |
Attrition | - Consider possibility of high attrition when calculating sample size | |
Staff caregiver factors | Time constraint & disruption to schedule | - Careful planning to minimize disruption - Offer financial compensation |
Turnover | - Recruitment of residents and study assessment carried out by investigators or RAs to reduce burden on LTC staff [28] | |
Low education level | - Improve training on staff caregivers [49] | |
Uncooperative attending physicians | - Offer a contract or letter of agreement [48] - Provide continuing education and online training [48] | |
Family caregiver factors | Constraint of their own physical condition, schedule, education level | - Carefully designed, concise, and easy to understand recruitment materials [24, 43] - Reduce travel/meeting time of family caregivers |
Sees no benefits to the resident | - Offer financial compensation [42] - Educate families about the benefits of participation e.g. more intense monitoring | |
Invasion of privacy | - Assure privacy despite difficulties [43] | |
Investigator factors | Seen as a threat or an outsider | - PI develop long-standing relationship with LTC facility [24, 47] |
High turnover of RAs | - Prioritize selection, training and support for RAs [34] | |
Ethical/legal factors | Obtaining consent legally and ethically | - Investigators should educate themselves about relevant regulations [32] - Establish standard procedures for obtaining consent |
Lack of internal REB that is familiar with LTC | - Collaborate with the LTC administration to determine which REB will be consulted | |
Methodological factors | Resident randomization | |
Outcome measures | - Use outcome measures designed specifically for LTC - Adapt outcome measures not specific to LTC if necessary [27, 33] | |
Budgetary factors | High cost | - Good planning and coordination to reduce costs - Budget cautiously with travel costs and site specific factors in mind |