U.S. Military Service Member Health Research Participation: Research Trends, Recruitment Challenges, and Reasons for Research Participation

Thesis (Ph.D.)--University of Washington, 2016-03Military-relevant health research often includes U.S. military service members as participants in studies of war-related conditions, such as traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Service members’ research participation contributes to advances that improve the wellbeing of all service members and supports military readiness. This dissertation explores current U.S. military service members’ participation in health research including (1) trends in participation, (2) indications of recruitment challenges, and (3) service members’ reasons for participation. The first paper reports trends in service members’ research participation. A review of ClinicalTrials.gov identified studies starting from 2005 to 2014 that included U.S. service members as participants, either exclusively or with other groups of participants. U.S. service members were participants in 512 studies. Service members participated together with other groups in 392 studies, while 120 studies included only service members. The top five conditions of interest were PTSD, TBI, amputations, burns, and ocular injuries/disorders. The number of studies started each year peaked in 2011 and declined from 2012 to 2014. The second paper identifies indications of difficulty recruiting service member research participants using data from ClinicalTrials.gov in 302 studies that included at least 25% U.S. service member research participants. Twelve percent of studies had been withdrawn, terminated, or suspended; enrollment and funding problems were the most common reasons. Only 44% of studies with all service member participants achieved 85% or more of enrollment goals. Findings support anecdotal reports suggesting difficulty recruiting service members as research participants, though findings did not differ significantly from a comparison group of studies with no or very few service members.. The third paper describes original research investigating the reasons current U.S. military service members decided to participate in health research. Fifteen service members with previous research participation experience were interviewed. Service members’ research decisions spanned three categories: self-focused, others-focused, and fit-focused. Seven subcategories were identified: curiosity, quality of life, helping researchers, making things better for others, opening doors, fitting the bill, and “why not?” Appealing to the reasons for which service members decide to participate in research can improve recruitment and facilitate research that meets service members’ needs