Implementing a prospective study of women seeking abortion in the United States: understanding and overcoming barriers to recruitment.
BACKGROUND
The Turnaway Study is designed to prospectively study the outcomes of women who sought-but did not all obtain-abortions. This design permits more accurate inferences about the health consequences of abortion for women, but requires the recruitment of a large number of women from remote health care facilities to a study a sensitive topic. This paper explores the Turnaway Study's recruitment process.


METHODS
From 2008 to 2010, the staff at 30 abortion-providing facilities recruited eligible female patients. Eight interventions were evaluated using multilevel logistic regression for their impact on eligible patients being approached, approached patients agreeing to go through informed consent by phone, and enrolled patients completing the baseline interview.


RESULTS
After site visits, patients had roughly twice the odds of being approached by facility staff and twice the odds of then agreeing to go through informed consent. When all recruitment steps were considered together, the net effect of site visits was to increase the odds that eligible patients participated by nearly a factor of six. After the introduction of a patient gift card incentive, patients had over three times the odds of agreeing to go through informed consent. With each passing month, however, staff demonstrated a 9% reduced odds of approaching eligible patients about the study.


CONCLUSIONS
Prioritizing scientific rigor over the convenience of using existing datasets, the Turnaway Study confronted recruitment challenges common to medical practice-based studies and unique to sensitive services. Visiting sites and communicating frequently with facility staff, as well as offering incentives to patients to hear more about the study before informed consent, may help to increase participation in prospective health studies and facilitate evaluation of sensitive women's health services.
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California; Division of Adolescent and Young Adult Medicine, University of California, San Francisco, San Francisco, California.
Loren M
LM
Dobkin
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California.
Heather
H
Gould
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California. Electronic address: bararr@obgyn.ucsf.edu.
Rana E
RE
Barar
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California.
Michaela
M
Ferrari
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California.
Elisette I
EI
Weiss
Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, California.
Diana Greene
DG
Foster
D000023:Abortion Applicants / Q000523:psychology*; D000028:Abortion, Induced; D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007258:Informed Consent; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D018579:Patient Selection; D011247:Pregnancy; D011446:Prospective Studies; D016079:Refusal to Treat; D014481:United States; D014932:Women's Health Services / Q000706:statistics & numerical data