Indigenous traumatic brain injury research: responding to recruitment challenges in the hospital environment

Fitts, Michelle S., Condon, Taeha, Gilroy, John, Bird, Katrina, Bleakley, Erica, Matheson, Lauren, Fleming, Jennifer, Clough, Alan R., Esterman, Adrian, Maruff, Paul, and Bohanna, India (2019) Indigenous traumatic brain injury research: responding to recruitment challenges in the hospital environment. BMC Medical Research Methodology, 19 (1). 172.

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Background: Hospitals are common recruitment sites for injury and disability studies. However, the clinical and rehabilitation environment can create unique challenges for researchers to recruit participant populations. While there is growing injury and disability focused research involving Indigenous people to understand the types of services and supports required by this population to enhance their recovery experiences, there is limited knowledge of researchers' experiences implementing recruitment processes in the tertiary hospital environment. This paper reflects on the specific challenges of recruiting Indigenous patients following a traumatic brain injury from two tertiary hospitals in Northern Australia.

Methods: Between July 2016 and April 2018, research staff recruited eligible patients from one hospital in Queensland and one hospital in the Northern Territory. Qualitative records summarising research staff contact with patients, family members and clinical hospital staff were documented. These qualitative records, in addition to field trip notes and researcher reflections were reviewed to summarise the main challenges in gaining access to patients who fit the eligibility criteria.

Results: During the recruitment process, there were five main challenges encountered: (1) Patients discharging against medical advice from hospital; (2) Discharge prior to formal emergence from Post Traumatic Amnesia as per the Westmead Post Trauma Amnesia Scale; (3) Patients under adult guardianship orders; (4) Narrow participant eligibility criteria and (5) Coordinating around patient commitments and treatment. Details of how the recruitment processes were modified throughout the recruitment phase of the study to ensure greater access to patients that met the criteria are described.

Conclusion: Based on our recruitment experiences, several recommendations are proposed for future TBI studies with Indigenous Australians. In addition to treatment, Indigenous TBI patients have wide range of needs that must be addressed while in hospital. Patient engagement and data collection processes should be flexible to respond to patient needs and the hospital environment. Employment of a centralized recruiter at each hospital site may help to minimise the challenges researchers need to navigate in the hospital environment. To improve recruitment processes in hospitals, it is essential for researchers examining other health or injury outcomes to describe their recruitment experiences.

Item ID: 60100
Item Type: Article (Research - C1)
ISSN: 1471-2288
Keywords: Methodology, Recruitment, Brain injury, Aboriginal and Torres Strait islander health, Disability, Westmead post-traumatic amnesia scale
Copyright Information: © The Author(s). 2019 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC Grant #1081947
Date Deposited: 21 Aug 2019 07:38
FoR Codes: 45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450401 Aboriginal and Torres Strait Islander and disability @ 100%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920399 Indigenous Health not elsewhere classified @ 100%
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