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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]
- Share research ownership [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 - Consider cluster randomization [3, 9]
- Consider quasi-experimental design [3, 9]
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