RECRUITMENT STRATEGIES

the main source of referral. Recruitment rates of people per practice per month were approximately 5.2, 4.6, 1.3 and 0.9 for schemes in Stockport, Powys, Islington and Swansea respectively. This last project was abandoned due to lack of numbers after six months. Both doctors and nurses have reported lack of time as a key barrier to promoting physical activ- ity.

Another approach to opportunistic recruitment is via medical centre waiting rooms. A randomised controlled trial in Newcastle attempted this approach but found that recruitment was often unwel- come and as a consequence slow. Recruitment by post was eventually intro- duced to boost the opportunistic recruit- ment.

PROS AND CONS Opportunistic recruitment has to date led to inappropriate referrals and low referral rates (0.9-5.2 patients per practice per month). Referral rates in the west London study using direct mail techniques were 16.8 patients per practice per month, over three times the rate of the best of the opportunistic schemes reported here. Both doctors and nurses are constrained by their lack of knowledge about physical activity and competing time demands. In order for this method of opportunistic recruitment to be more successful physi- cal inactivity will have to be given a higher priority in primary care and prima- ry care staff will require further training

about the health benefits of physical activity in different populations.

2. Flagging medical notes RESEARCH EVIDENCE A more targeted approach to reaching subjects is via medical records. A ran- domised controlled trial of exercise pro- motion in primary care targeted men and women aged 40-70 who were either hypertensive, smokers or overweight. Suitable subjects were identified by searching medical notes. They were then sent a letter of invitation. Three hundred and forty five patients were invited to take part in the study with 41% (141) eventually doing so. Sixty three per cent of those entering the study were female. Differences between responders and non- responders were examined and revealed that non-responders were significantly more likely to be smokers. Patients who were overweight were significantly more likely to enter the study than normal weight patients but there were no differ- ences between groups for hypertension. Those entering into the study were already engaging in approximately 2.5 hours of at least moderate intensity phys- ical activity per week.

PROS AND CONS Flagging of medical notes can better identify target populations and does not require the time of health professionals as this part of the recruitment process can be done by an administrator. However,

depending on the number of criteria required for eligibility for a programme this can be a difficult and time-consum- ing task. When the target group is identi- fied by age only, computerised registers can be used and subjects identified more quickly.

The next stage of the recruitment process for this more targeted method is more problematic. In the Eastbourne study, patients identified from medical records were sent an invitation to take part in a referral programme via the post. This led to quite a large drop out and meant those who received the intervention were already reasonably active and more likely to be women.

3. Direct mail RESEARCH EVIDENCE A primary care trial based in two general practices in West London sent a lifestyle questionnaire to all registered patients aged 45-74 years. Patients in the target age range were identified from computer records using a simple report facility. This process was simpler than searching either electronic or paper medical records for specific inclusion criteria. Respondents categorised as ‘insufficiently active’ (less than 20 x 30 minute episodes of moder- ate intensity exercise or less than 12 x 20 minute episodes of vigorous intensity exercise, in the previous 4 weeks) were

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