Recruitment of patients for STI screening in the emergency department

Background – Recruiting patients to participate in sexually transmitted infection (STI) studies in the emergency department (ED) is difficult, and participation rates are typically poor (<59%). However, the prevalence of chlamydia and gonorrhea in ED patients frequently exceeds 8% and 4%, respectively, demonstrating that EDs can be important sites for screening. Objective – To identify potential factors in our current ED STI screening study contributing to our high participation rate. Methods – A qualitative review of participant reasons, recruiter observations, and study design factors. Results – From Aug 15-Dec 30, 2011, 122 of 175 (69.7%) females agreed to participate by completing a survey and providing a urine sample. Non-participating subjects were often accompanied by another person or reported current involvement in a committed relationship. Participating subjects cited “fear of being infected” or belief their partner had other sex partners. Recruiter observations included a subject preference for female recruiter, recruitment after receipt of primary treatment, and recruiting patients with minor illnesses versus those critically ill. The study design included a $10.00 cash incentive, but multiple participants stated this did not influence their decision. Conclusions – Patient recruitment in the ED for STI screening is feasible and potentially highly successful. The purposeful incorporation of factors contributing to participation may make recruitment in screening more effective. The financial incentive may be a barrier to some programs, but is likely highly cost-effective considering the potential morbidity associated with untreated STI. Further work should examine the utility of specific engagement strategies to reduce reliance upon incentives and increase participation.