‘They are with me on this journey’, the importance of participant-researcher relationships on attendance at follow-up in a behavioural weight management trial: a qualitative study of participant perspectives

BACKGROUND: Retaining people for the duration of a trial or study can be challenging. This has been a particular difficulty for trials of behavioural weight management programmes. Poor retention can detrimentally impact data quality, validity, reliability, and knowledge translation. A number of behavioural strategies (for example reminders or monetary rewards) have been implemented to improve retention at follow-up in trials. However, research in this area is limited, the evidence is uncertain, and has not considered wider strategies such as style of delivery or the role of participant-researcher relationships within trial processes. The aim of this qualitative study was to explore participant views and experiences of follow-up weight assessments. METHODS: Participants (n = 390) were randomised to protocolised weight assessments, scheduled at 3 and 6 months. These were implemented in an embedded study within a trial of a 12-month text-based behavioural weight management programme. Participants received a task-oriented approach focused on completing weight verification and the case report form or a relational approach focused on building the participant relationship. Assessments were delivered by researchers at three recruiting centres (Belfast, Bristol, and Glasgow). Framework method was used to analyse transcripts of semi-structured interviews with participants. RESULTS: Fifty-four trial participants took part in interviews. Three overarching themes were constructed from the narratives: the value of attending follow-up weight assessments, mode of weight assessment delivery, and contextual and practical factors influencing attendance at weight assessments. The themes provided novel insights into attendance at follow-up outcome assessments in a weight management trial including the emotive nature of attending weight assessments, related to weight stigma. Little distinguished the two groups. Participants spoke of positive relationships with researchers, benefitted from the researcher role within assessments, and desired in-person human contact, each considered by participants to enhance attendance. CONCLUSION: Participant-researcher relationships have an important role in retention. How researchers approach trial processes, such as outcome assessments, could improve attendance within weight management trials primarily by supporting motivation through mechanisms of change such as a sense of responsibility or accountability. Removal of connection through digital-only interventions, with limited in-person follow-up, has potential implications for retention. SWAT REGISTRATION: Northern Ireland Hub for Trials Methodology Research SWAT 147, 1/04/2020.