title: Lessons learned from recruiting socioeconomically disadvantaged smokers into a pilot randomized controlled trial to explore the role of Exercise Assisted Reduction then Stop (EARS) smoking.
abstract: BACKGROUND
  Research is needed on what influences recruitment to smoking reduction trials, and how to increase their reach. The present study aimed to i) assess the feasibility of recruiting a disadvantaged population, ii) examine the effects of recruitment methods on participant characteristics, iii) identify resource requirements for different recruitment methods, and iv) to qualitatively assess the acceptability of recruitment. This was done as part of a pilot two-arm trial of the effectiveness of a novel behavioral support intervention focused on increasing physical activity and reducing smoking, among disadvantaged smokers not wishing to quit.
  
  
  METHODS
  Smokers were recruited through mailed invitations from three primary care practices (62 participants) and one National Health Stop Smoking Service (SSS) database (31 participants). Six other participants were recruited via a variety of other community-based approaches. Data were collected through questionnaires, field notes, work sampling, and databases. Chi-squared and t-tests were used to compare baseline characteristics of participants.
  
  
  RESULTS
  We randomized between 5.1 and 11.1% of those invited through primary care and SSS, with associated researcher time to recruit one participant varying from 18 to 157 minutes depending on time and intensity invested.Only six participants were recruited through a wide variety of other community-based approaches, with an associated researcher time of 469 minutes to recruit one participant. Targets for recruiting a disadvantaged population were met, with 91% of the sample in social classes C2 to E (NRS social grades, UK), and 41% indicating mental health problems. Those recruited from SSS were more likely to respond to an initial letter, had used cessation aids before, and had attempted to quit in the past year. Overall, initial responders were more likely to be physically active than those who were recruited via follow-up telephone calls. No other demographics or behaviour characteristics were associated with recruitment approach or intensity of effort. Qualitative feedback indicated that participants had been attracted by the prospect of support that focused on smoking reduction rather than abrupt quitting.
  
  
  CONCLUSIONS
  Mailed invitations, and follow-up, from health professionals was an effective method of recruiting disadvantaged smokers into a trial of an exercise intervention to aid smoking reduction. Recruitment via community outreach approaches was largely ineffective.
  
  
  BACKGROUND
  ISRCTN identifier: 13837944 , registered on 6 July 2010.
authors.affiliation: Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK. tom.thompson@plymouth.ac.uk.
authors.forename: Tom P
authors.initials: TP
authors.lastname: Thompson
authors.affiliation: University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. C.J.Greaves@exeter.ac.uk.
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Greaves
authors.affiliation: Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK. richard.ayres@plymouth.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Ayres
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Walton Street, Jericho, Oxford, OX2 6NW, UK. paul.aveyard@phc.ox.ac.uk.
authors.forename: Paul
authors.initials: P
authors.lastname: Aveyard
authors.affiliation: University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. F.C.Warren@exeter.ac.uk.
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Warren
authors.affiliation: Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK. richard.byng@plymouth.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Byng
authors.affiliation: University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. R.Taylor@exeter.ac.uk.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
authors.affiliation: University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. john.campbell@exeter.ac.uk.
authors.forename: John L
authors.initials: JL
authors.lastname: Campbell
authors.affiliation: Institute of Population Health Research, St George's University of London, Cranmer Terrace, London, SW17 ORE, UK. mussher@sgul.ac.uk.
authors.forename: Michael
authors.initials: M
authors.lastname: Ussher
authors.affiliation: Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK. s.michie@ucl.ac.uk.
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.affiliation: Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, Gower Street, London, WC1E 6BT, UK. robert.west@ucl.ac.uk.
authors.forename: Robert
authors.initials: R
authors.lastname: West
authors.affiliation: Plymouth University Peninsula School of Medicine and Dentistry, ITTC Building, Plymouth Science Park, Plymouth, PL6 8BX, UK. adrian.taylor@plymouth.ac.uk.
authors.forename: Adrian H
authors.initials: AH
authors.lastname: Taylor
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D004739:England / Q000453:epidemiology; D005081:Exercise Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D010865:Pilot Projects; D011177:Postal Service; D015995:Prevalence; D011320:Primary Health Care; D036301:Qualitative Research; D035842:Research Subjects / Q000523:psychology*; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D013222:State Medicine; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome; D035862:Vulnerable Populations / Q000523:psychology*