RESEARCH Open AccessWho does not participate in telehealthtrials and why? A cross-sectional surveyAlexis Foster 1* , Kimberley A Horspool 1 , Louisa Edwards 2 , Clare L Thomas 2 , Chris Salisbury 2 , Alan A Montgomery 3and Alicia O’Cathain 1AbstractBackground: Telehealth interventions use information and communication technology to provide clinical support.Some randomised controlled trials of telehealth report high patient decline rates. A large study was undertaken todetermine which patients decline to participate in telehealth trials and their reasons for doing so.Methods: Two linked randomised controlled trials were undertaken, one for patients with depression and one forpatients with raised cardiovascular disease risk (the Healthlines Study). The trials compared usual care withadditional support delivered by the telephone and internet. Patients were recruited via their general practice andcould return a form about why they were not participating.Results: Of the patients invited, 82.9 % (20,021/24,152) did not accept the study invite, either by returning a declineform (n = 7134) or by not responding (n = 12,887). In both trials patients registered at deprived general practiceswere less likely to accept the study invite. Decline forms were received from 29.5 % (7134/24,152) of patients invited.There were four frequently reported types of reasons for declining. The most common was telehealth-related: 54.7 %(3889/,7115) of decliners said they did not have access or the skills to use the internet and/or computers. This wasmore prevalent amongst older patients and patients registered at deprived general practices. The second was healthneed-related: 40.1 % (n=2852) of decliners reported that they did not need additional support for their healthcondition. The third was related to life circumstances: 27.2 % (n=1932) of decliners reported being too busy.The fourth was research-related: 15.3 % (n=1092) of decliners were not interested in the research.Conclusions: A large proportion of patients declining participation in these telehealth trials did so because theywere unable to engage with telehealth or did not perceive a need for it. This has implications for engagement withtelehealth in routine practice, as well as for trials, with a need to offer technological support to increase patients’engagement with telehealth. More generally, triallists should assess why people decline to participate in their studies.Trial registration: The Healthlines Study has the following trial registrations: depression trial: ISRCTN14172341(registered 26 June 2012) and CVD risk trial: ISRCTN27508731 (registered 05 July 2012).Keywords: Telehealth, Trials, Declines, Recruitment, Non-participation, RefusersBackground“Telehealth is the remote exchange of data between a pa-tient at home and their clinician(s) to assist in diagnosisand monitoring typically used to support patients withLong Term Conditions” [1]. Examples of telehealth in-clude online cognitive behavioural therapy, home moni-toring of health parameters such as blood pressure andinternet-based health forums. Globally, telehealth isbecoming a prominent part of healthcare delivery.Telehealth interventions are increasingly being tested inrandomised controlled trials (RCTs). Some of these tele-health trials have reported high decline rates of over75 % amongst potential participants [2, 3]. A recent re-view of 37 telehealth studies found an average declinerate of 32 %, but this varied between 4 % and 71 % forthe individual studies; and only two studies were RCTs[4]. Decline rates may vary because of the health condi-tion under study. For example, some patient groups are* Correspondence: alexis.foster@sheffield.ac.uk1 School of Health and Related Research, University of Sheffield, Regent Court,30 Regent Street, Sheffield S1 4DA, UKFull list of author information is available at the end of the articleTRIALS© 2015 Foster et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Foster et al. Trials (2015) 16:258 DOI 10.1186/s13063-015-0773-3
