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Abstract
Objectives This study aims to highlight problems with recruiting to an English stool sample community prevalence study. It was part of a larger cross-sectional research to determine the risk factors for the presence of extended-spectrum beta-lactamase and carbapenemase-producing coliforms in stool samples of the asymptomatic general English population.
Setting Four National Health Service primary care trusts (PCTs) of England representing a different section of the population of England: Newham PCT; Heart of Birmingham Teaching PCT; Shropshire County PCT; and Southampton City PCT.
Participants Sixteen general practices across the four PCTs were purposefully selected. After stratification of GP lists by age, ethnicity and antibiotic use, 58 337 randomly selected patients were sent a postal invitation.
Patients who had died, moved to a different surgery, were deemed too ill by their General Practitioner or hospitalised at the time of mailing were excluded.
Results Stool and questionnaire returns varied by area, age, gender and ethnicity; the highest return rate of 27.3% was in Shropshire in the age group of over 60 years; the lowest, 0.6%, was in Birmingham in the age group of 18–39 years. Whereas only 3.9%(2296) returned a completed questionnaire and stool sample, 94.9% of participants gave permission for their sample and data to be used in future research.
Conclusion Researchers should consider the low stool specimen return rate and wide variation by ethnicity and age when planning future studies involving stool specimen collection. This is particularly pertinent if the study has no health benefit to participants. Further research is needed to explore how to improve recruitment in multicultural communities and in younger people.
- primary care
- public health
- postal recruitment
- epidemiology
- microbiology
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Footnotes
DML and DN-S contributed equally.
Contributors DL (March-July 2014 and from April 2015) was involved in data collection and data management, was a steering group member. DN-S was involved in ethics application, practice and participant recruitment, data collection and entry. DL and DN-S contributed equally to this paper . TN was grant co-applicant, involved in study design, practice and participant selection, data management, data analysis, was a steering group member, and contributed to the writing of the manuscript. PH was grant co-applicant and involved in literature review, study design, questionnaire design, laboratory supervision, data interpretation, was a steering group member and contributed to the writing of the manuscript. KT involved in participant recruitment and liaison, data collection and entry, and agreed the final manuscript. MT was grant co-applicant and involved in study and questionnaire design, Steering Group member, Primary Care Lead, practice selection and commented on the manuscript. HLT was grant co-applicant and involved in study and questionnaire design, data interpretation, was a steering group member and commented on the manuscript. LX-M was a grant co-applicant and involved in study design, laboratory supervision, supported laboratory data management, was a steering group member and contributed to the writing of the manuscript. SSh involved in laboratory work and data collection, and agreed the final manuscript. SM involved in laboratory work and data collection, and agreed the final manuscript. AA-B was involved in laboratory work and data cleaning, and agreed the final manuscript. SSm was grant co-applicant and involved in study design, was a steering group member, and commented on the manuscript. K-TC involved in laboratory work, recording and data entry and agreed the final manuscript. CM led the writing of the grant application and protocol, was involved in the literature review, contributed to the design of the questionnaire, led the project steering group and led the writing of the manuscript.
Funding The report is based on independent research commissioned andfunded by the NIHR Policy Research Programme (Ref. 041/0038S). The viewsexpressed in the publication are those of the author(s) and not necessarilythose of the NHS, the NIHR, the Department of Health, ‘arms’ length bodies orother government departments.
Competing interests All findings and observations are original unless otherwise acknowledged.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval Ethical approval for the study was obtained from the NRES Committee South West -Frenchay, Bristol, UK (13/SW/0017). The data we collected from GP practices were anonymous.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The relevant anonymised patient level data are available on reasonable request from the authors.