Retention and attrition in bariatric surgery research: an integrative review of the literature

Abstract

Background: Bariatric surgery research, often longitudinal, bears the challenge of maintaining retention and decreasing attrition of participants to avoid bias.

Objectives: To explore factors influencing the retention and attrition for bariatric surgical research participants.

Methods: Databases searched included: PubMed, CINAHL, Scopus, and others. As a secondary aim, studies reporting on retention/attrition factors in clinical follow-up visits were included.

Results: Of the 1145 articles retrieved, 44 met inclusion criteria, and underwent qualitative analysis. Four descriptive articles focused on longitudinal research participation and 40 on clinical follow-up visits. Willingness to participate in research was high (92%) and decreased with more invasive procedures or extra visits. A large observational longitudinal study presented 24-month retention/attrition data (92% for some data and 66% visit completion) and the retention strategies employed. One study indicated that research follow-up possibly increased clinical follow-up and another demonstrated a higher retention by increasing compensation. No consistent, modifiable demographic or psychosocial variables associated or predictive of retention or attrition in clinical follow-up were identified.

Conclusions: Research on factors related to participant retention and attrition is sparse. It is essential for studies to document retention/attrition data. Existing research has demonstrated a patient willingness to participate in research and that retention strategies have been successful in the short term. Further research should explore the motivations, perspectives and attitudes of bariatric surgical research participants regarding participation and explore predictors to develop evidence-based retention strategies. Research has yet to identify consistent and modifiable demographic or psychosocial variables predictive of clinical follow-up, possibly due to the heterogeneity of follow-up across studies. Further investigation into follow-up definition, content, counseling approaches, and new telemedicine technologies may prove helpful in developing predictors and evidence-based strategies. The relationship between research and clinical retention and attrition deserves further characterization.

Keywords: Aftercare; Attrition; Bariatric surgery; Follow-up; Longitudinal research; Patient compliance; Retention; Retention strategies.