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Table 3 The 7 Ps lessons learned and changes made

From: Using marketing theory to inform strategies for recruitment: a recruitment optimisation model and the txt2stop experience

The 7 Ps

Lessons learned and changes made

Product

EH reviewed the clinical trials and smoking cessation literature using the MEDLINE database and key search terms “recruitment and trials”, “smoking cessation”, and years 1960 to 2007. A range of reasons for participating in trials was identified from the literature.

General core benefits: The opportunity to receive an intervention not otherwise available and the satisfaction of contributing to research [33, 41]. Trial specific core benefits: The prospects of saving money, of improved health, of wanting to avoid damage to an unborn baby, and of quitting for one’s loved ones.

Price (cost)

Insights from social psychology theories were used to influence potential participants’ perceptions of the psychological costs to (non) participation [42].

Social validation theory: Knowing that others similar to oneself have joined can provide reassurance that joining is the right decision [43].

Norms of reciprocity: Receiving small financial and other incentives can increase participants’ willingness to cooperate [44].

Theory of scarcity: Scarcity can act a heuristic for the perceived value of a medical intervention [45].

£5 was sent to prospective participants with their covering letter to induce norms of reciprocity and to dismiss concerns that the trial could be a scam (i.e., charge for text messages received) [46]. Text messages were sent to participants who had registered and were eligible to join, to remind them that they could consent and that only 300 places were left (as was the case at the time) [47].

 

To smokers

Promotion communication

Theories of persuasion suggest testimonials can generate positive responses [28, 48]. Qualitative feedback from participants about their experience with txt2stop was obtained and with permission used in text messages sent to potential participants who had received the trial information but had not yet consented.

The study information was personalised, shortened, and simplified, as the literature on trial participation suggested people might be more responsive to such types of communication [2, 35, 49]. The content was amended to mention the product tangible and general core benefits, that trial participation offered the possibility of trying a free and novel service, and that the research could be used by the NHS [50]. To signal trustworthiness all correspondence included university logos and was personally signed [3, 29, 36].

New newspaper advertisements were prepared to increase public interest. These promoted the benefits to quitting (product core benefits) and used testimonials to maximise the impact of the message. Previous advertisements merely made people aware of txt2stop.

To health care providers

Smoking cessation literature suggested health care professionals can act as important triggers for quit attempts [51]. Yet, very few participants had been recruited through health care providers. GPs interviewed reported that remembering and workload were issues, so recruitment through GP surgeries was redesigned. GPs were reimbursed via the PCRN for admin staff writing to smokers on their lists inviting them to take part in the trial. Pharmacists reported wanting paying for recruitment but at the time there was no mechanism for funding this. Smoking cessation services received funds for smokers they helped to quit and so they had no incentive to refer smokers on. No further effort was put into promotions through these channels. However, a txt2stop link was placed on the NHS smoking cessation websites.

Place

Not applicable to txt2stop, interaction occurred over the phone.

People

Adequately managing “moments of truth” in the participant/staff interaction, such as responding convincingly to a challenging query, and minimising “response rate tyranny” (annoyance and harassment) is key to engaging potential participants [9, 52].

Through informal observations and through semi-structured phone interviews held with a sample of individuals who had refused consent, participants’ concerns and misconceptions that were unique to txt2stop were spotted. Staff received training to address concerns such as that DNA testing was secretly linked to the provision of a saliva sample. Staff also received training on how to deal with awkward and busy participants and on how to show empathy towards those who were allocated to the control group while reminding them they still had an important role to play in the trial. Capitalising on the good rapport that phone staff had with participants, staff asked participants to promote the trial by word of mouth.

Physical environment

Not applicable to txt2stop, interaction occurred over the phone.

Process

Online registration (instead of just by phone) was made available for busy and hard to reach individuals and promoted in the voice messages left on their mobiles and also by a series of text messages.