{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:36:33Z","timestamp":1785404193010,"version":"3.56.0"},"reference-count":50,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23AG080068"],"award-info":[{"award-number":["K23AG080068"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"award":["K23AG080068"],"award-info":[{"award-number":["K23AG080068"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Wisconsin Alzheimer\u2019s Disease Research Center Grant","award":["P30-AG062715"],"award-info":[{"award-number":["P30-AG062715"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Recruiting care partners (CPs) of hospitalized people living with dementia is challenging due to rapid discharge timelines and complex inpatient workflows. This study identified barriers to CP recruitment encountered during the first year of a hospital-based randomized controlled trial and the strategies implemented in response to them. Methods: A qualitative descriptive study using thematic analysis of twelve study coordination and implementation meeting transcripts was conducted. Recruitment outcomes were examined to assess changes before and after implementation of the enhanced recruitment workflow. Results: Eight recruitment barriers were identified, including fragmented electronic health record (EHR) documentation, uncertainty in CP presence, limited clinician availability, passive study promotion, and inefficient clinical\u2013research team collaboration. Nine strategies were developed and implemented in response to these barriers. The enhanced recruitment workflow was temporally associated with an increase in average monthly enrollment from 0.25 participants (April\u2013July 2024) to 4 participants (August 2024\u2013December 2025). Over the same periods, the cumulative enrollment rate was 3% and 23%, respectively. Conclusions: Care partner recruitment in inpatient settings is highly context-dependent and requires iterative, implementation-informed adaptation. Effective recruitment may be supported by embedding processes into routine inpatient workflows, clarifying recruitment roles, leveraging EHR-supported identification, and maintaining close clinical\u2013research team collaboration to respond to the unpredictable presence of care partners and short discharge windows.<\/jats:p>","DOI":"10.3390\/ijerph23040447","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T09:26:12Z","timestamp":1775121972000},"page":"447","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and Strategies for Recruiting Care Partners During the Hospitalization of People Living with Dementia: Lessons from a Hospital-Based Randomized Controlled Trial"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5461-1320","authenticated-orcid":false,"given":"Te-Lien","family":"Ku","sequence":"first","affiliation":[{"name":"Clinical Practice, Innovation, and Research Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5635-9528","authenticated-orcid":false,"given":"Kayla","family":"Dillon","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henry","family":"Karelitz","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Mortensen","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly C.","family":"VanDenBergh","sequence":"additional","affiliation":[{"name":"UW Health University Hospital, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7044-633X","authenticated-orcid":false,"given":"Dani M.","family":"Edwards","sequence":"additional","affiliation":[{"name":"UW Health University Hospital, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Quarcoo","sequence":"additional","affiliation":[{"name":"UW Health University Hospital, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney M.","family":"Kuhlman","sequence":"additional","affiliation":[{"name":"UW Health University Hospital, Madison, WI 53792, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly M.","family":"Gerhardt","sequence":"additional","affiliation":[{"name":"UW Health East Madison Hospital, Madison, WI 53718, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6048-3460","authenticated-orcid":false,"given":"\u00c9lise N.","family":"Arsenault Knudsen","sequence":"additional","affiliation":[{"name":"School of Nursing, University of Wisconsin-Madison, Madison, WI 53706, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8192-7144","authenticated-orcid":false,"given":"Beth","family":"Fields","sequence":"additional","affiliation":[{"name":"Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1017\/S1041610221000557","article-title":"Caring for caregivers\/care partners of persons with dementia","volume":"33","author":"Jeste","year":"2021","journal-title":"Int. Psychogeriatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e59291","DOI":"10.2196\/59291","article-title":"Recruitment challenges and strategies in a technology-based intervention for dementia caregivers: Descriptive study","volume":"9","author":"Ko","year":"2025","journal-title":"JMIR Form. Res."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Joshi, S., Park, T., Brody, L., Cruz, K., Mukhi, P., Reid, M.C., Herr, K., Pillemer, K., and Riffin, C. (2023). Recruitment of family caregivers of persons with dementia: Lessons learned from a pilot randomized controlled trial. Front. Pain Res., 4.","DOI":"10.3389\/fpain.2023.1125914"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"927","DOI":"10.3233\/JAD-201081","article-title":"Modifiable barriers for recruitment and retention of older adults participants from underrepresented minorities in Alzheimer\u2019s disease research","volume":"80","author":"Indorewalla","year":"2021","journal-title":"J. Alzheimers Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1023\/A:1006798316654","article-title":"Working with culture: A qualitative analysis of barriers to the recruitment of Chinese-American family caregivers for dementia research","volume":"15","author":"Hinton","year":"2000","journal-title":"J. Cross Cult. Gerontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15333175241276443","DOI":"10.1177\/15333175241276443","article-title":"Recruiting persons with dementia: A systematic review of facilitators, barriers, and strategies","volume":"39","author":"Hirt","year":"2024","journal-title":"Am. J. Alzheimers Dis. Other Demen."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/WAD.0000000000000149","article-title":"Recruiting dementia caregivers into clinical trials: Lessons learnt from the Australian TRANSCENDENT trial","volume":"30","author":"Leach","year":"2016","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"gnae189","DOI":"10.1093\/geront\/gnae189","article-title":"How do researchers identify and recruit dementia caregivers? A scoping review","volume":"65","author":"Kashyap","year":"2025","journal-title":"Gerontologist"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1001\/jama.297.8.831","article-title":"Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care","volume":"297","author":"Kripalani","year":"2007","journal-title":"JAMA"},{"key":"ref_10","unstructured":"World Health Organization (2025, December 01). Dementia. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/dementia."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1377\/hlthaff.2024.00978","article-title":"The number of family caregivers helping older US adults increased from 18 million to 24 million, 2011\u20132022","volume":"44","author":"Wolff","year":"2025","journal-title":"Health Aff."},{"key":"ref_12","unstructured":"Alzheimer\u2019s Association (2025). 2025 Alzheimer\u2019s disease facts and figures. Alzheimer\u2019s Dement., 21, e70235."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2865","DOI":"10.1002\/alz.12901","article-title":"The worldwide costs of dementia in 2019","volume":"19","author":"Wimo","year":"2023","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_14","unstructured":"Administration on Community Living (2025, July 24). 2022 National Strategy to Support Family Caregivers, Available online: https:\/\/acl.gov\/sites\/default\/files\/RAISE_SGRG\/NatlStrategyToSupportFamilyCaregivers-2.pdf."},{"key":"ref_15","first-page":"e70115","article-title":"Using co-design to adapt the care partner hospital assessment tool for dementia","volume":"17","author":"Fields","year":"2025","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3390\/nursrep11030049","article-title":"The development and content validation of the care partner hospital assessment tool","volume":"11","author":"Fields","year":"2021","journal-title":"Nurs. Rep."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e46808","DOI":"10.2196\/46808","article-title":"Adapting and testing the care partner hospital assessment tool for use in dementia care: Protocol for a 2 sequential phase study","volume":"12","author":"Fields","year":"2023","journal-title":"JMIR Res. Protoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G","article-title":"Whatever happened to qualitative description?","volume":"23","author":"Sandelowski","year":"2000","journal-title":"Res. Nurs. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2333393617742282","DOI":"10.1177\/2333393617742282","article-title":"Employing a qualitative description approach in health care research","volume":"4","author":"Bradshaw","year":"2017","journal-title":"Glob. Qual. Nurs. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1080\/0142159X.2020.1755030","article-title":"Thematic analysis of qualitative data: AMEE Guide No. 131","volume":"42","author":"Kiger","year":"2020","journal-title":"Med. Teach."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"16094069231205789","DOI":"10.1177\/16094069231205789","article-title":"A step-by-step process of thematic analysis to develop a conceptual model in qualitative research","volume":"22","author":"Naeem","year":"2023","journal-title":"Int. J. Qual. Methods"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"157S","DOI":"10.1177\/0898264304269727","article-title":"Social marketing as a framework for recruitment: Illustrations from the REACH study","volume":"16","author":"Nichols","year":"2004","journal-title":"J. Aging Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1002\/nur.20466","article-title":"Recruitment and enrollment of caregivers for a lifestyle physical activity clinical trial","volume":"35","author":"Etkin","year":"2012","journal-title":"Res. Nurs. Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1177\/0269216318757623","article-title":"Using the \u2018social marketing mix framework\u2019 to explore recruitment barriers and facilitators in palliative care randomized controlled trials? A narrative synthesis review","volume":"32","author":"Dunleavy","year":"2018","journal-title":"Palliat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1188\/14.ONF.545-547","article-title":"The use of triangulation in qualitative research","volume":"41","author":"Carter","year":"2014","journal-title":"Oncol. Nurs. Forum."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1177\/1049732316654870","article-title":"Member checking: A tool to enhance trustworthiness or merely a nod to validation?","volume":"26","author":"Birt","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e13762","DOI":"10.1111\/tct.13762","article-title":"How to discuss transferability of qualitative research in health professions education","volume":"21","author":"Stalmeijer","year":"2024","journal-title":"Clin. Teach."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1080\/13814788.2017.1375092","article-title":"Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing","volume":"24","author":"Korstjens","year":"2018","journal-title":"Eur. J. Gen. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lincoln, Y.S., and Guba, E.G. (1985). Naturalistic Inquiry, SAGE.","DOI":"10.1016\/0147-1767(85)90062-8"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1017\/cts.2023.16","article-title":"Community engagement strategies to promote recruitment and participation in clinical research among rural communities: A narrative review","volume":"7","author":"Brockman","year":"2023","journal-title":"J. Clin. Transl. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ngo, V., Leykum, L.K., Kalvesmaki, A.F., Dang, S., No\u00ebl, P.H., Pugh, M.J., Delgado, R.E., Bouldin, E.D., Parish, J., and Trivedi, R.B. (2025). Caregiver recruitment and engagement: Identifying best practices and strategies for including family caregivers of veterans in health services research. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-025-13368-3"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1177\/0733464814532012","article-title":"Recruiting community-based dementia patients and caregivers in a nonpharmacologic randomized trial: What works and how much does it cost?","volume":"35","author":"Morrison","year":"2016","journal-title":"J. Appl. Gerontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1097\/WAD.0000000000000419","article-title":"Tailoring research recruitment for acute care settings: Recommendations from people with dementia and their caregivers","volume":"35","author":"Friz","year":"2021","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e59584","DOI":"10.2196\/59584","article-title":"Improving how caregivers of people living with dementia are identified in the electronic health record: Qualitative study and exploratory chart review","volume":"7","author":"Green","year":"2024","journal-title":"JMIR Aging"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e45274","DOI":"10.2196\/45274","article-title":"Care partner inclusion of people hospitalized with Alzheimer disease and related dementias: Protocol for a mixed methods systems engineering approach to designing a health care system toolkit","volume":"12","author":"Fields","year":"2023","journal-title":"JMIR Res. Protoc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1111\/jgs.18673","article-title":"Alerting providers to hospitalized persons with dementia using the electronic health record","volume":"72","author":"Tan","year":"2024","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1186\/s13063-024-08288-2","article-title":"Caregiver recruitment strategies for interventions designed to optimize transitions from hospital to home: Lessons from a randomized trial","volume":"25","author":"Gustavson","year":"2024","journal-title":"Trials"},{"key":"ref_38","first-page":"MR000036","article-title":"Strategies designed to help healthcare professionals to recruit participants to research studies","volume":"2","author":"Preston","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"afac098","DOI":"10.1093\/ageing\/afac098","article-title":"Patterns of unplanned hospital admissions among people with dementia: From diagnosis to the end of life","volume":"51","author":"Yorganci","year":"2022","journal-title":"Age Ageing"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/1478-4505-13-8","article-title":"Barriers and opportunities for enhancing patient recruitment and retention in clinical research: Findings from an interview study in an NHS academic health science centre","volume":"13","author":"Adams","year":"2015","journal-title":"Health Res. Policy Syst."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1017\/cts.2021.852","article-title":"Strengthening the clinical research workforce through a competency-based orientation program: Process outcomes and lessons learned across three academic health institutions","volume":"5","author":"Musshafen","year":"2021","journal-title":"J. Clin. Transl. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.cnur.2009.07.011","article-title":"Science, technology, and innovation: Nursing responsibilities in clinical research","volume":"44","author":"Grady","year":"2009","journal-title":"Nurs. Clin. N. Am."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"107579","DOI":"10.1016\/j.chiabu.2025.107579","article-title":"The dual role of family nurses in recruiting and screening of underserved populations for a randomized controlled trial","volume":"167","author":"Finne","year":"2025","journal-title":"Child Abuse Negl."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e46","DOI":"10.1017\/S146342362300035X","article-title":"What are the experiences of nurses delivering research studies in primary care?","volume":"24","author":"Ballintine","year":"2023","journal-title":"Prim. Health Care Res. Dev."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"French, C., and Stavropoulou, C. (2016). Specialist nurses\u2019 perceptions of inviting patients to participate in clinical research studies: A qualitative descriptive study of barriers and facilitators. BMC Med. Res. Methodol., 16.","DOI":"10.1186\/s12874-016-0204-5"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1177\/1744987108098228","article-title":"A qualitative study exploring practice nurses\u2019 experience of participating in a primary care-based randomised controlled trial","volume":"14","author":"Potter","year":"2009","journal-title":"J. Res. Nurs."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1080\/08897077.2021.1900987","article-title":"Trust in research physicians as a key dimension of randomized controlled trial participation in clinical addictions research","volume":"42","author":"Jaffe","year":"2021","journal-title":"Subst. Abus."},{"key":"ref_48","unstructured":"University of Alberta (2025, December 07). Caregiver-Centered Care. Available online: https:\/\/www.caregivercare.ca\/."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"3936","DOI":"10.1111\/jgs.19061","article-title":"Optimizing better health and care for older adults and their family caregivers: A review of geriatric approaches","volume":"72","author":"Fields","year":"2024","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e101098","DOI":"10.1002\/alz70858_101098","article-title":"Recruiting care partners of hospitalized people living with dementia: Insights from a pilot randomized controlled trial","volume":"21","author":"Ku","year":"2025","journal-title":"Alzheimer\u2019s Dement."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/447\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T03:13:13Z","timestamp":1775445193000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijerph23040447"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23040447","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]}}}