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

Leandro Galli1*, Rosemary Knight2, Steven Robertson2, Elizabeth Hoile1, Olubukola Oladapo1, David Francis3 and Caroline Free4

Author Affiliations

1 London School of Hygiene and Tropical Medicine, Coventry CV4 7AL, UK

2 Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

3 Centre for Research and Innovation Management, University of Brighton, Brighton BN2 0JG, UK

4 Department of Population Health, Clinical Trials Unit, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

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Trials 2014, 15:182  doi:10.1186/1745-6215-15-182

Published: 22 May 2014



Recruitment is a major challenge for many trials; just over half reach their targets and almost a third resort to grant extensions. The economic and societal implications of this shortcoming are significant. Yet, we have a limited understanding of the processes that increase the probability that recruitment targets will be achieved. Accordingly, there is an urgent need to bring analytical rigour to the task of improving recruitment, thereby increasing the likelihood that trials reach their recruitment targets. This paper presents a conceptual framework that can be used to improve recruitment to clinical trials.


Using a case-study approach, we reviewed the range of initiatives that had been undertaken to improve recruitment in the txt2stop trial using qualitative (semi-structured interviews with the principal investigator) and quantitative (recruitment) data analysis. Later, the txt2stop recruitment practices were compared to a previous model of marketing a trial and to key constructs in social marketing theory.


Post hoc, we developed a recruitment optimisation model to serve as a conceptual framework to improve recruitment to clinical trials. A core premise of the model is that improving recruitment needs to be an iterative, learning process. The model describes three essential activities: i) recruitment phase monitoring, ii) marketing research, and iii) the evaluation of current performance. We describe the initiatives undertaken by the txt2stop trial and the results achieved, as an example of the use of the model.


Further research should explore the impact of adopting the recruitment optimisation model when applied to other trials.

Marketing mix; Marketing model; Recruitment performance; Social marketing; Turnaround; Txt2stop