Barriers to recruitment of an observational SARS-CoV-2 emergency department cohort at Boston Medical Center

Background: Successful recruitment of study participants is a challenging component of research, and recruitment barriers are amplified in safety-net hospital (SNH) settings. However, engaging historically underrepresented groups in research is critically important to improve health disparities and outcomes. We summarize challenges we encountered while recruiting patients with COVID-19 from the emergency department (ED), actions to improve inclusivity, and implementation hurdles in an SNH setting. Methods: We conducted an observational study at the largest safety-net hospital in New England, recruiting patients in the ED with confirmed COVID-19. Investigators prioritized recruitment inclusivity through language translations of study materials, compensation (including transport and travel reimbursement), flexible sample delivery options, and clinical staff engagement. We identified and categorized major impediments to recruitment success. Results: Recruitment and retention efforts were largely unsuccessful ( n  = 4 enrolled of n = 113 eligible by electronic medical record (EMR) review. Barriers to recruitment success included clinical teams’ perception of good candidacy, persistent language barriers, limited consent capacity, burden of participation, and ED discharge logistics. Conclusions: Despite efforts to improve opportunities to participate in research, SNH EDs present unique challenges for recruitment. Study teams should prioritize clinical staff engagement and work with institutions to promote inclusivity and community engagement efforts to improve research engagement in these settings.