Can audit and feedback be applied to target healthcare professionals recruitment and retention behaviour in RCTs? A mixed methods exploration

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More than 7 million participants have been required to participate in clinical trials registered thus far in 2022 alone. In the UK, the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme spent £100 million on trials during 2019-2020. In addition to being expensive, clinical trials often fail to deliver due to problems with trial conduct, process which involves behaviours. Trial conduct is not currently conceptualised through this behavioural lens, yet, behaviours are at the heart of clinical trial delivery and the social science discipline of behavioural science can provide critical insights for the clinical trials community- improving health by improving research.Recruitment and/or retention continue to be the biggest challenge for successful trial delivery. For example, only 56% of UK NIHR HTA funded trials recruited their sample size, and some suffered loss to follow up of up to 77%. In efforts to improve recruitment and retention trials share data on these activities with staff at recruiting sites. This typically involves comparisons with other sites, such as the best recruiting and retaining sites, with the aim of changing the behaviour of clinical staff. This information is often fed back as newsletters or reports. This assessment of recruitment and retention activity compared to a 'standard' reported back to sites can be considered as audit and feedback (A&F) a widely used, evidence based, component of healthcare quality improvement. The existing target driven strategies to improve trial recruitment and retention are not currently conceptualised as A&F behaviour change strategies and as such the potential for effectiveness of this evidence based behavioural approach has not been maximised. In addition several studies have highlighted that the process of recruitment to trials is influenced by complex social phenomena that require in depth understanding in order to unpack. This studentship aims to address this gap.