Doctors’ perspectives on law and life-sustaining treatment: Survey design and recruitment strategies for a challenging cohort

- Background Palliative medicine and other specialists play significant legal roles in decisions to withhold and withdraw life-sustaining treatment at the end of life. Yet little is known about their knowledge of or attitudes to the law, and the role they think it should play in medical practice. Consideration of doctors’ views is critical to optimizing patient outcomes at the end of life. However, doctors are difficult to engage as participants in empirical research, presenting challenges for researchers seeking to understand doctors’ experiences and perspectives. - Aims To determine how to engage doctors involved in end-of-life care in empirical research about knowledge of the law and the role it plays in medical practice at the end of life. - Methods Postal survey of all specialists in palliative medicine, emergency medicine, geriatric medicine, intensive care, medical oncology, renal medicine, and respiratory medicine in three Australian states: New South Wales, Victoria, and Queensland. The survey was sent in hard copy with two reminders and a follow up reminder letter was also sent to the directors of hospital emergency departments. Awareness was further promoted through engagement with the relevant medical colleges and publications in professional journals; various incentives to respond were also used. The key measure is the response rate of doctors to the survey. - Results Thirty-two percent of doctors in the main study completed their survey with response rate by specialty ranging from 52% (palliative care) to 24% (medical oncology). This overall response rate was twice that of the reweighted pilot study (16%). - Conclusions Doctors remain a difficult cohort to engage in survey research but strategic recruitment efforts can be effective in increasing response rate. Collaboration with doctors and their professional bodies in both the development of the survey instrument and recruitment of participants is essential.

The Dark Side of the Moon: Meta-analytical Impact of Recruitment Strategies on Risk Enrichment in the Clinical High Risk State for Psychosis

Background: The individual risk of developing psychosis after being tested for clinical high-risk (CHR) criteria (posttest risk of psychosis) depends on the underlying risk of the disease of the population from which the person is selected (pretest risk of psychosis), and thus on recruitment strategies. Yet, the impact of recruitment strategies on pretest risk of psychosis is unknown. Methods: Meta-analysis of the pretest risk of psychosis in help-seeking patients selected to undergo CHR assessment: total transitions to psychosis over the pool of patients assessed for potential risk and deemed at risk (CHR+) or not at risk (CHR−). Recruitment strategies (number of outreach activities per study, main target of outreach campaign, and proportion of self-referrals) were the moderators examined in meta-regressions. Results: 11 independent studies met the inclusion criteria, for a total of 2519 (CHR+: n = 1359; CHR−: n = 1160) help-seeking patients undergoing CHR assessment (mean follow-up: 38 months). The overall meta-analytical pretest risk for psychosis in help-seeking patients was 15%, with high heterogeneity (95% CI: 9%–24%, I 2 = 96, P < .001). Recruitment strategies were heterogeneous and opportunistic. Heterogeneity was largely explained by intensive (n = 11, β = −.166, Q = 9.441, P = .002) outreach campaigns primarily targeting the general public (n = 11, β = −1.15, Q = 21.35, P < .001) along with higher proportions of self-referrals (n = 10, β = −.029, Q = 4.262, P = .039), which diluted pretest risk for psychosis in patients undergoing CHR assessment. Conclusions: There is meta-analytical evidence for overall risk enrichment (pretest risk for psychosis at 38monhts = 15%) in help-seeking samples selected for CHR assessment as compared to the general population (pretest risk of psychosis at 38monhts=0.1%). Intensive outreach campaigns predominantly targeting the general population and a higher proportion of self-referrals diluted the pretest risk for psychosis.

Using police crash databases for injury prevention research - a comparison of opt-out and opt-in approaches to study recruitment

Objective: The study aimed to examine the difference in response rates between opt-out and opt-in participant recruitment in a population-based study of heavy-vehicle drivers involved in a police-attended crash. Methods: Two approaches to subject recruitment were implemented in two different states over a 14-week period and response rates for the two approaches (opt-out versus opt-in recruitment) were compared. Results: Based on the eligible and contactable drivers, the response rates were 54% for the optout group and 16% for the opt-in group. Conclusions and Implications: The opt-in recruitment strategy (which was a consequence of one jurisdiction’s interpretation of the national Privacy Act at the time) resulted in an insufficient and potentially biased sample for the purposes of conducting research into risk factors for heavy-vehicle crashes. Australia’s national Privacy Act 1988 has had a long history of inconsistent practices by state and territory government departments and ethical review committees. These inconsistencies can have profound effects on the validity of research, as shown through the significantly different response rates we reported in this study. It is hoped that a more unified interpretation of the Privacy Act across the states and territories, as proposed under the soon-to-be released Australian Privacy Principles will reduce the recruitment challenges outlined in this study.

Gen Y recruitment: Understanding graduate intentions to join an organisation using the Theory of Planned Behaviour

Purpose Using the Theory of Planned Behaviour (TPB) framework, this study explored whether the standard TPB constructs explained variance in Gen Y individuals’ intentions to join their ideal organisation. Design/methodology/approach A mixed methods approach was used featuring qualitative and quantitative methods. Findings The overall TPB model accounted for a significant 51.6% of the variance in intention to join one’s ideal organisation in the next six months with the significant predictors in the model being subjective norm and perceived behaviour control but not attitude. Research limitations/implications Using graduating students from a single Australian university sample may mean that the current findings may not extend to all Gen Y individuals. The current study has demonstrated the explanatory utility of the TPB in relation to graduate Gen Y’s intention to join their ideal organisation, providing further evidence of the robustness of the TPB framework in an organisational setting. Practical implications These findings have implications for enhancing understanding of the most effective recruitment processes for Gen Y students entering the workforce. The findings could inform recruitment policies and strategies to attract Gen Y applicants. Originality/value To our knowledge this study is the first application of the TPB to this topic. The current research extends the recruitment literature with a theoretically-based investigation. Identification of factors which inform organisational recruitment strategies, allow organisations to stand out from their competitors and potentially achieve a larger application pool from which to select the best human capital and sustain competitive advantage.

Recruiting older adults to health research studies : a systematic review

Objective: To provide a systematic review of papers comparing the effectiveness of different strategies to recruit older adults (aged 50 years and over) to participate in health research studies, to guide successful recruitment in future research. Methods: Four major databases were searched for papers published between 1995 and 2008 with: target group aged 50 years or over; participants allocated to receive one of two or more recruitment strategies; and an outcome measure of response rate or enrolment in study. Results: Twelve papers were included in the review. Conclusion: For postal questionnaires, recruitment strategies used with older adults had comparable outcomes to those used to recruit from the general population. For other types of studies, strategies involving face-to-face contact may be more effective than indirect methods, but this needs to be balanced against feasibility. Overall, little evidence on the topic exists and more rigorous investigation is necessary.

Attraction and image for the Australian rail industry

Despite the global financial downturn, the Australian rail industry is in a period of expansion. Reports indicate that the industry is not attracting sufficient entry level and mid-career engineers and skilled technicians from within the Australian labour market and is facing widespread retirements from an ageing workforce. This paper reports on a completed qualitative study that explores the perceptions of engineering students, their lecturers, careers advisors and recruitment consultants regarding rail as a brand and of careers in the rail industry. Findings are presented about career knowledge, job characteristic preferences, branding and image and indicate that rail as a brand has a dated image, that young people and their influencers have little knowledge of rail careers and that rail could better focus its image and recruitment strategies. Conclusions include suggestions for more effective attraction and image strategies for the industry and for further research.

The impact of completing a drink driving rehabilitation program on future drinking : the clients’ perspective

The paper explores the role and focus of drink driving rehabilitation programs. It is particularly concerned with whether programs that specifically focus on reducing driving after drinking also have a positive effect on clients’ levels of drinking. A sample of volunteering clients was recruited while they were participating in the Australian “Under the Limit” program and they were followed up at least three months post completion. Response rates were very low and the sample is assumed to reflect the views and outcomes of persons who felt positive about the program. Clients reported large and meaningful reductions in their drinking and in their drink driving. They also reported important moves towards action and change in their drinking habits. The findings deserve to be followed up given the fact that drink driving programs are generally of much shorter duration than alcohol focussed interventions. There is a need for further research in this area and for developing more effective recruitment strategies.

Ask : a health advocacy program for adolescents with an intellectual disability : a cluster randomised controlled trial

Background Adolescents with intellectual disability often have poor health and healthcare. This is partly as a consequence of poor communication and recall difficulties, and the possible loss of specialised paediatric services. Methods/Design A cluster randomised trial was conducted with adolescents with intellectual disability to investigate a health intervention package to enhance interactions among adolescents with intellectual disability, their parents/carers, and general practitioners (GPs). The trial took place in Queensland, Australia, between February 2007 and September 2010. The intervention package was designed to improve communication with health professionals and families’ organisation of health information, and to increase clinical activities beneficial to improved health outcomes. It consisted of the Comprehensive Health Assessment Program (CHAP), a one-off health check, and the Ask Health Diary, designed for on-going use. Participants were drawn from Special Education Schools and Special Education Units. The education component of the intervention was delivered as part of the school curriculum. Educators were surveyed at baseline and followed-up four months later. Carers were surveyed at baseline and after 26 months. Evidence of health promotion, disease prevention and case-finding activities were extracted from GPs clinical records. Qualitative interviews of educators occurred after completion of the educational component of the intervention and with adolescents and carers after the CHAP. Discussion Adolescents with intellectual disability have difficulty obtaining many health services and often find it difficult to become empowered to improve and protect their health. The health intervention package proposed may aid them by augmenting communication, improving documentation of health encounters, and improving access to, and quality of, GP care. Recruitment strategies to consider for future studies in this population include ensuring potential participants can identify themselves with the individuals used in promotional study material, making direct contact with their families at the start of the study, and closely monitoring the implementation of the educational intervention.

Modelling the salient factors influencing retired business professionals' participation in episodic skilled volunteering in rural settings

Retired business professionals represent an unexplored source of skill support for struggling rural communities. This research examined the feasibility of drawing on this valuable pool of knowledge and experience by engaging retirees in short term, project based volunteering roles in rural, not for profit agencies. Using the theory of planned behaviour and the functional approach to volunteering, the program of study generated a model comprising the key psychological and contextual factors determining the volunteers' decision to provide skill assistance in rural settings. The model provides a useful resource for creating suitable volunteering opportunities and for informing volunteer recruitment strategies.

The influence of social media on international students' choice of university and course

This thesis is a qualitative study of the influence of social media on the university and course decision making process of international students. It examines the role of social media in influencing international students' decisions on course and university selection and the role of social media in meeting their information needs. It also gathered inputs on how universities could engage, collaborate and communicate using social media communities and channels for more effective recruitment strategies.

Labor Regulations and Unionization Trends: Comparative Analysis of Latin American Countries

This paper discusses the influences of labor regulations on unionization rates through the comparative analysis of Argentina, Chile and Mexico, expecting to contribute to the understanding of the determinants of unionization in Latin America. These regulations, though only one of the factors determining unionization levels, have a crucial role, their influence being at least threefold: they define entitlements to and exclusions from the right to unionize, affect union recruitment strategies and, by generating incentives and disincentives, contribute to shape individual membership decisions. After discussing historical aspects of unionization in the three countries, the analysis centers successively in two periods in which the countries compared showed both similarities and contrasts relevant to the analysis of unionization trends. In the first, the comparison is between Argentina (1976-83) and Chile (1973-89), both under military regimes that had much in common, but with contrasting unionization trends. In the second, the focus is in Argentina (1991-2001) and Mexico (1984-2000), where the reforms implemented to liberalize the economy and ensuing social-economic and labor market transformations were similar, but unionization trends differed. It is argued that, in each case, the divergent behavior of unionization, in spite of the similar economic and sociopolitical contexts, may at least partly be attributed to differences in key labor institutions.

Control aspects in proportionality Markov manpower systems

In this paper, the control aspects of a hierarchical organization under the influence of "proportionality" policies are analyzed. Proportionality policies are those that restrict the recruitment to every level of the hierarchy (except the bottom most level or base level) to be in strict proportion to the promotions into that level. Both long term and short term control analysis have been discussed. In long term control the specific roles of the parameters of the system with regard to control of the shape and size of the system have been analyzed and yield suitable control strategies. In short term control, the attainability of a target or goal structure within a specific time from a given initial structure has been analyzed and yields the required recruitment strategies. The theoretical analyses have been illustrated with computational examples and also with real world data.

Control aspects in proportionality Markov manpower systems

In this paper, the control aspects of a hierarchical organization under the influence of "proportionality" policies are analyzed. Proportionality policies are those that restrict the recruitment to every level of the hierarchy (except the bottom most level or base level) to be in strict proportion to the promotions into that level. Both long term and short term control analysis have been discussed. In long term control the specific roles of the parameters of the system with regard to control of the shape and size of the system have been analyzed and yield suitable control strategies. In short term control, the attainability of a target or goal structure within a specific time from a given initial structure has been analyzed and yields the required recruitment strategies. The theoretical analyses have been illustrated with computational examples and also with real world data. The control of such proportionality systems is then compared with that of the general systems (which do not follow such policies) with some significant conclusions. The control relations of such proportionality systems are found to be simpler and more practically feasible than those of general Markov systems, which do not have such restrictions. Such proportionality systems thus not only retain and match the flexibility of general Markov systems but also have the added advantage of simpler and more practically feasible controls. The proportionality policies hence act as an alternative and more practicably feasible means of control. (C) 2004 Elsevier Inc. All rights reserved.

A Delicate Balancing Act: Negotiating with Gatekeepers for Ethical Research When Researching Minority Communities

Research and processes of knowledge production are often based on racialised and imperialistic frameworks that have either led to the exclusion or pathologisation of minority groups. Researchers address issues of exclusion by adopting recruitment strategies that involve negotiating with gatekeepers to ensure the inclusion of minority or marginalised groups. This often involves in-depth scrutiny of gatekeepers and requires the researchers to negotiate deals and to make personal disclosures. However, there remains relatively little discussion on the pragmatic ethical issues facing researchers in the field as a result of these interactions.
This paper suggests that interactions with gatekeepers present ethical issues that can be effectively addressed and managed by researchers through the exercise of phronesis. This allows researchers to make critical ethical decisions based on the specific characteristics of the research sites and subjects, not least of which are those issues that emerge as a consequence of researcher positionality. Such decisions are not necessarily identified or accommodated through bureaucratic processes which govern research ethics. We advance the notion of research ethics as an ongoing process that requires researcher skills and engagement, rather than one where it is a one off bureaucratic exercise.